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

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Death certificates may inaccurately list an address for homeless individuals, particularly younger ones. This misclassification highlights the need for improved data collection on homelessness at the time of death.

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Area of Science:

  • Public Health
  • Mortality Statistics
  • Social Determinants of Health

Background:

  • Homelessness in the United States is a significant public health issue linked to increased health risks and premature mortality.
  • Accurate classification of homeless status is crucial for understanding its impact but presents data collection challenges.
  • The validity of using death certificates to ascertain homelessness requires careful examination.

Purpose of the Study:

  • To assess the accuracy of homeless status ascertainment on death certificates.
  • To compare homeless classification from medical examiner data with vital record data.
  • To identify potential causes of misclassification of homelessness on death certificates.

Main Methods:

  • Quantitative comparison of homeless status from Multnomah County medical examiner data (gold standard) with vital record (death certificate) data from 2023.
  • Description of individuals indicated as homeless in medical examiner data but not in vital records.
  • Analysis of potential reasons for misclassification.

Main Results:

  • Of 394 decedents classified as homeless by medical examiner data, 171 (43%) had an address listed on their death certificate.
  • Decedents with an address on their death certificate but classified as homeless were younger (42 years) than those with concordant records (46 years).

Conclusions:

  • An address on a death certificate does not exclude homelessness at the time of death, especially for younger individuals.
  • Jurisdictions should evaluate the accuracy of their homeless classification data on death certificates.
  • Further research is needed to quantify the extent of misclassification of homelessness in mortality data.