Reading the article attached to this post might put you in mind of banging your head against a brick wall.
The article is about a project to calculate mortality rates among people who were homeless in the United States from 2011 to 2020. It is written by Matthew Fowle, who is based at the University of Pennsylvania and Giselle Routhier, who is at New York University. Both study population health.
The research is a very ambitious undertaking, partly because there is no national register of deaths by housing status. The authors had to track down and decide how to code data from 22 separate sources.
As well, to calculate mortality rates, it is necessary know how many people are homeless. HUD (the US Department of Housing and Urban Development) reports annually on the number of people who are homeless, but there are issues with the methods used to determine to the number. For example, the criteria for counting a person as homeless excludes a lot of people who do not have permanent housing. As well, data collection relies heavily on a count that is undertaken by volunteers. Using HUD’s number creates limitations for the findings, but there really aren’t any other options.
So why did Fowle and Routhier, take on this challenge? Here are a few thoughts:
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- Mortality rates are central to population health research. Mortality rates are a basic tool to identify people who share common characteristics and disparities between groups. Fowle and Routhier’s research found that people who are homeless are far more likely to die than people who have housing. This was already known to be the case in some cities. Fowle and Routhier’s data confirmed this finding at a national level.
- Tracking mortality rates over time is one way to measure whether things are getting better or worse for specific population group. In the case of people experiencing homelessness, the mortality rate increased between 2011 and 2020. The mortality rate rose a lot more than the mortality rate for the general population in the same period. If you were homeless at age 30 in 2020, you were two and a half times more likely to die than if you were homeless at age 30 in 2011. Fowle and Routhier were so struck by the trend that they gave it a name: mortal systemic exclusion.
- Mortality rate research allows us to track changes in the cause of death. For people who are homeless, an overdose of drugs or alcohol is the leading cause of death. Meanwhile, among the housed population, death by overdose does not even appear on a list of the ten leading causes of death. It is thanks to Fowle and Routhier’s research that this disparity has come to light.
- Mortality rates can guide service provision. Homeless people are more likely to die from an overdose than any other cause. Housed people are not. This finding leads Fowle and Routhier to conclude,
“The most effective form of mortality prevention is preventing the occurrence of homelessness in the first place.”
You can read about Fowle and Routhier’s research in Health Affairs: Mortal Systemic Exclusion Yielded Steep Mortality-Rate Increases In People Experiencing Homelessness, 2011–20
