{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T09:13:25Z","timestamp":1783588405208,"version":"3.55.0"},"reference-count":22,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"unspecified","delay-in-days":43,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["U54MD015946"],"award-info":[{"award-number":["U54MD015946"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,4,29]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>People experiencing homelessness are at disproportionate risk of premature mortality. In Harris County, Texas, USA, mortality has continued to rise despite reductions in unsheltered homelessness. The extent and timing of housing and social service engagement preceding these deaths remain poorly understood yet may help inform whether and how service engagement could play a role in prevention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study included 417 adults who died while experiencing homelessness in Harris County between January 2021 and December 2022. Medical examiner records were probabilistically linked to the regional Homeless Management Information System (HMIS) to assess service engagement from January 2020 until death. Bivariate analyses compared decedents with and without HMIS records and among those in HMIS, individuals with and without recent service interactions (\u226412 months before death).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The median age at death was 55 years. Just over half of decedents (53.48%) had an HMIS record but only 29.50% had a recent service interaction. The most frequently documented services were basic needs provision and case management while street outreach engaged the largest number of individuals. Significant racial and ethnic differences were observed, with Hispanic and non-Hispanic Asian decedents less likely to have used services compared with non-Hispanic Black and non-Hispanic White decedents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Nearly half of those who died while experiencing homelessness had no documented service record, and fewer than one-third had any recent engagement, highlighting limited connection with services prior to death. Strengthening continuity and frequency of contact, expanding culturally responsive outreach and enhancing pathways to housing-focused services may support improved engagement and risk identification, though their implications for mortality require further investigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-003952","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T13:20:45Z","timestamp":1778764845000},"page":"e003952","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Cross-sectional characterisation of housing and social service engagement prior to death among adults experiencing homelessness in Harris County, Texas, USA"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4508-7337","authenticated-orcid":false,"given":"Carlie","family":"Stratemann","sequence":"first","affiliation":[{"name":"School of Public Health, The University of Texas Health Science Centre at Houston, Houston, Texas, USA"},{"name":"Health Systems and Population Health Sciences, University of Houston Tilman J Fertitta Family College of Medicine, Houston, Texas, USA"},{"name":"D. Bradley McWilliams School of Biomedical Informatics, The University of Texas Health Science Centre at Houston, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2392-7664","authenticated-orcid":false,"given":"Shaya","family":"Khorsandi","sequence":"additional","affiliation":[{"name":"Louisiana State University School of Medicine, New Orleans, Louisiana, USA"},{"name":"School of Public Health, Louisiana State University Health Sciences Centre New Orleans, New Orleans, Louisiana, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7787-4637","authenticated-orcid":false,"given":"Shriya","family":"Swamy","sequence":"additional","affiliation":[{"name":"School of Public Health, The University of Texas Health Science Centre at Houston, Houston, Texas, USA"},{"name":"Health Systems and Population Health Sciences, University of Houston Tilman J Fertitta Family College of Medicine, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"Lin","sequence":"additional","affiliation":[{"name":"Health Systems and Population Health Sciences, University of Houston Tilman J Fertitta Family College of Medicine, Houston, Texas, USA"},{"name":"School of Human Ecology, Public Health Program, The University of Texas at Austin, Austin, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8248-5547","authenticated-orcid":false,"given":"Ben","family":"King","sequence":"additional","affiliation":[{"name":"Health Systems and Population Health Sciences, University of Houston Tilman J Fertitta Family College of Medicine, Houston, Texas, USA"},{"name":"Humana Integrated Health Systems Sciences Institute, University of Houston, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"2026070901203313000_4.2.e003952.1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2023.01039"},{"key":"2026070901203313000_4.2.e003952.2","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-017-1456-z"},{"key":"2026070901203313000_4.2.e003952.3","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1353\/hpu.2022.0035","article-title":"The Impact of Homelessness on Mortality of Individuals Living in the United States: A Systematic Review of the Literature","volume":"33","author":"Funk","year":"2022","journal-title":"J Health Care Poor Underserved"},{"key":"2026070901203313000_4.2.e003952.4","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1001\/jamainternmed.2018.2924","article-title":"Mortality Among Unsheltered Homeless Adults in Boston, Massachusetts, 2000-2009","volume":"178","author":"Roncarati","year":"2018","journal-title":"JAMA Intern Med"},{"key":"2026070901203313000_4.2.e003952.5","unstructured":"National Bureau of Economic Research . Estimating mortality rates for the us homeless population. NBER Digest; 2024. Available: https:\/\/www.nber.org\/digest\/202402\/estimating-mortality-rates-us-homeless-population"},{"key":"2026070901203313000_4.2.e003952.6","doi-asserted-by":"crossref","unstructured":"Meyer BD , Wyse A , Logani I . Life and death at the margins of society: the mortality of the u.s. homeless population.nber working paper. National Bureau of Economic Research; 2023. 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Fertitta Family College of Medicine, University of Houston; 2024. Available: https:\/\/www.uh.edu\/medicine\/_documents\/2023-harris-county-homelessness-mortality-report--pub-dec2024.pdf"},{"key":"2026070901203313000_4.2.e003952.21","unstructured":"U.S. Department of Housing and Urban Development . Definition of chronic homelessness. U.S. Department of Housing and Urban Development. 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