The Hidden Health Crisis: Mortality and Morbidity Among People Experiencing Homelessness
Story
Homelessness is not only a social crisis but a profound public health issue. In Illinois, between 2017 and 2022, thousands of individuals experienced homelessness, with approximately 10,000 people living in shelters or on the streets each year, in addition to a staggering number of individuals—between 111,463 and 238,823—living in unstable housing situations. Together, these populations face not only the hardships of unstable housing but also severe health disparities that dramatically shorten their lifespans and quality of life.
A recent report from the Illinois Department of Public Health (IDPH), authored by the University of Illinois Chicago School of Public Health, provides an in-depth look at the mortality and morbidity of people experiencing homelessness (PEH) in the state. The findings are stark, revealing troubling trends in both the causes of death and hospital utilization among this vulnerable population.
A Stark Disparity in Mortality
Between 2017 and 2022, 2,520 deaths were recorded among individuals experiencing homelessness in Illinois. Significantly, there has been a sharp rise in PEH deaths since the onset of the COVID-19 pandemic, with deaths increasing by 36.6% for this group, compared to just 6.1% in the general population. This trend underscores the added vulnerability of those without stable housing.
The average age at death for people experiencing homelessness was 56.3 years, nearly 20 years younger than the state’s general population, which had an average age at death of 74.2 years. People experiencing homelessness died disproportionately from drug-related overdoses (32.9% vs. 3.4%), traumatic injuries (12.3% vs. 3.6%), and extreme weather conditions, such as excessive cold (3.8% vs. 0.1%). Perhaps most troubling, the homicide rate among people experiencing homelessness was almost three times higher than in the general population, with victims disproportionately young, Black, and male.
Health Risks and Hospital Utilization
The health challenges faced by PEH are not limited to mortality; they also have severe consequences for overall health. Between 2017 and 2022, over 1.4 million hospital visits were recorded for PEH in Illinois. Many of these visits were related to chronic conditions such as hypertension, respiratory diseases, substance use disorders, and mental health issues like depression and psychosis. Furthermore, a troubling 15-20% of hospital visits were for injuries, with thousands of visits related to assaults and suicide attempts.
“The health concerns of people experiencing homelessness are not limited to psychiatric conditions and substance use disorders,” said UIC Professor Lee Friedman, an author of the report along with Dana Madigan, PhD and Hannah Matzke, PhD. “People experiencing homelessness with chronic health conditions have a very high level of hospital utilization, and among those that died, the majority were suffering from chronic conditions at their time of death.”
For those who utilized hospital services, the experience was marked by frequent visits. Individuals with homelessness-related hospital codes had a median of 14 visits over six years, with those requiring high levels of care facing complex conditions like cardiovascular disease, respiratory disorders, and substance use. Even after hospitalization, however, many returned to shelters or the streets, making follow-up care and treatment challenging, if not impossible.
The Path Forward: Health-Promoting Interventions
Public health infrastructure is built around prevention, and this report highlights the need to increase health promoting interventions and preventative services for chronic conditions to appropriately address the health disparities disproportionately faced by people experiencing homelessness. Homelessness is not inevitable but is driven by structural issues such as housing costs and gaps in social safety nets.
UIC Research Assistant Professor Dana Madigan noted, “The focus for many jurisdictions has been on mortality data, which provides clear insights on the health impacts of those experiencing homelessness, but this report’s additional analysis of hospitalization data can inform interventions at earlier stages that can have a larger impact. This is especially relevant for addressing the chronic health needs of this population and drivers of increased hospital use when someone is identified as experiencing homelessness compared to times when they are not.”
The findings from this report provide a call to action for policymakers, healthcare providers, and community organizations to work together to ensure access to stable housing and comprehensive health care to reduce the devastating impacts of homelessness on public health.