Misclassification of Homeless Status at Death, Multnomah County, Oregon, 2023

Homelessness is a pervasive and pressing problem in the United States and is associated with health risks and premature mortality. However, accurately defining and classifying homeless status can be complex, and assessment of homelessness status requires careful consideration of the data collection process. We assessed the validity of the ascertainment of homeless status on death certificates.

We quantitatively compared the classification of homeless status from 2023 Multnomah County, Oregon, medical examiner data (considered the gold-standard source, due to the in-depth investigation and extensive data available as a case narrative) with housing status from Oregon Health Authority 2023 vital record (death certificate) data alone. We also described people with an indication of homelessness in the 2023 medical examiner data but not in the 2023 vital record data and considered possible causes of this misclassification.

A total of 171 of 394 (43%) decedents whom we classified as homeless via medical examiner data had an address listed in the final death certificate; all were significantly younger (aged 42 y) than the 223 people with concordant records (aged 46 y).

We found that the presence of an address on a death certificate does not rule out homelessness at the time of death, especially among younger decedents. Other jurisdictions should assess the accuracy of their homeless classification data, as more research is necessary to quantify the presence of misclassification.