Factors Associated With Rising Homelessness Within US States, 2019 to 2024

Homelessness has risen sharply in the US in recent years, posing a major threat to population health. Although researchers have identified factors contributing to differences in homelessness prevalence between jurisdictions, factors contributing to year-over-year change in homelessness are poorly understood.

To examine competing explanations for rising levels of homelessness within US states between 2019 and 2024.

This longitudinal cohort study was conducted to measure the association between changing state-level factors and relative change in counts of people experiencing homelessness from 2019 to 2024. The sample comprised adults (aged ≥18 years) and children (aged <18 years) experiencing homelessness in all 50 states and Washington, DC, as measured in the US Department of Housing and Urban Development point-in-time (PIT) homeless count data. Due to PIT count limitations owing to the pandemic, outcome data for 2021 were excluded.

State-year average rents, unemployment, pandemic-era housing supports (including emergency rental assistance and eviction moratoria), substance use (proxied by overdoses), immigration, and climate-related property damage were measured via a variety of publicly available datasets.

The primary outcome was year-over-year change in homelessness within states overall, by homelessness type (sheltered or unsheltered), and by age (children or adults).

From 2019 to 2024 (excluding 2021; N = 255 state-years), eviction moratoria and climate-related damages were consistently associated with change in homelessness within the 50 states and Washington, DC. The mean (SD) year-over-year increase in homelessness was 7.0% (22.5%), and there were mean (SD) changes of 6.1% (29.1%) for sheltered homelessness, 16.0% (36.5%) for unsheltered homelessness, 7.2% (20.6%) for adult homelessness, and 8.4% (44.0%) for child homelessness. Each additional 1.0% of person-time covered by a moratorium was associated with a 0.36-percentage point (pp) lower increase in homelessness (95% CI, 0.10-0.61 pp; P = .01). Each home-equivalent lost to climate-related events per 10 000 population was associated with a 1.00-pp greater increase in overall homelessness (95% CI, 0.78-1.22 pp; P < .001). Results were largely consistent by homelessness type and age. Whereas the mean (SD) year-over-year increase in homelessness was 11.0% (36.4%) for a typical state in 2022, homelessness would have risen by an estimated 19.9% (95% CI, 13.5%-26.3%) absent eviction moratoria, while counts would have risen by only 7.8% (95% CI, 7.1%-8.5%) absent property loss due to climate-related disasters.

In this cohort study of 50 states and Washington, DC, measured over 5 years, eviction moratoria and climate-related damages were associated with within-state, relative change in homelessness. These findings suggest that to attenuate surges in homelessness, policymakers should take action to prevent evictions and address climate change.