{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T08:57:34Z","timestamp":1793350654064,"version":"4.5.0"},"reference-count":29,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Public Health Rep"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00333549251386001","type":"journal-article","created":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T06:12:38Z","timestamp":1765606358000},"page":"565-571","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Misclassification of Homeless Status at Death, Multnomah County, Oregon, 2023"],"prefix":"10.1177","volume":"141","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9265-9990","authenticated-orcid":false,"given":"Jaime","family":"Walters","sequence":"first","affiliation":[{"name":"Community Epidemiology Services, Public Health Division, Multnomah County Health Department, Portland, OR, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Mosites","sequence":"additional","affiliation":[{"name":"Community Epidemiology Services, Public Health Division, Multnomah County Health Department, Portland, OR, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0244-7458","authenticated-orcid":false,"given":"Eric","family":"Hall","sequence":"additional","affiliation":[{"name":"Oregon Health &amp; Science University\u2013Portland State University, Portland, OR, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan M.","family":"Snowden","sequence":"additional","affiliation":[{"name":"Oregon Health &amp; Science University\u2013Portland State University, Portland, OR, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,12,12]]},"reference":[{"key":"#cr-split#-e_1_3_2_2_2.1","unstructured":"de Sousa T Andrichik A Prestera E Rush K Tano C Wheeler M. The 2023 Annual Homelessness Assessment Report (AHAR) to Congress. Part 1: Point-in-Time Estimates of Homelessness. US Department of Housing and Urban Development Office of Community Planning and Development"},{"key":"#cr-split#-e_1_3_2_2_2.2","unstructured":"December 2023. Accessed November 1 2024. https:\/\/www.huduser.gov\/portal\/sites\/default\/files\/pdf\/2023-ahar-part-1.Pdf"},{"key":"e_1_3_2_3_2","unstructured":"US Census Bureau. American Community Survey demographic and housing estimates. 2023. Accessed November 1 2024. https:\/\/data.census.gov\/table\/ACSDP1Y2023.DP05?q=multnomahcountyoregon&y=2023"},{"key":"e_1_3_2_4_2","unstructured":"Zapata M Greene J Niehaus C et al. 2023 Point in Time Findings Report: Count of People Experiencing Homelessness in Clackamas Multnomah and Washington Counties Oregon. Homelessness Research and Action Collaborative Portland State University; 2024. Accessed November 1 2024. https:\/\/pdxscholar.library.pdx.edu\/cgi\/viewcontent.cgi?article=1047&context=hrac_pub"},{"key":"e_1_3_2_5_2","unstructured":"Portland Housing Bureau. State of Housing in Portland 2024. Part 2: Housing Market Affordability. 2025. Accessed June 23 2025. https:\/\/www.portland.gov\/phb\/documents\/state-housing-portland-2024-part-2-housing-market-affordability\/download"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2022.0035"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2023.01039"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/00333549241228525"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/00333549231215850"},{"key":"e_1_3_2_10_2","unstructured":"Oregon Health Authority. Senate Bill 850: domicile unknown. Accessed January 5 2025. https:\/\/www.oregon.gov\/oha\/ph\/birthdeathcertificates\/registervitalrecords\/pages\/senate-bill-850.aspx"},{"key":"e_1_3_2_11_2","unstructured":"Oregon Revised Statutes. Chapter 146: investigations of deaths injuries and missing persons. 2023. Accessed September 11 2025. https:\/\/www.oregonlegislature.gov\/bills_laws\/ors\/ors146.html"},{"key":"e_1_3_2_12_2","unstructured":"Multnomah County Health Department. Domicile unknown: medical examiner review of deaths among people experiencing homelessness in Multnomah County in 2011. 2012. Accessed January 5 2025. https:\/\/multco.us\/file\/domicile_unknown_report%3A_2011\/download"},{"key":"e_1_3_2_13_2","unstructured":"Cornell Law School Legal Information Institute. 42 USC \u00a71302: general definition of homeless individual. Accessed January 5 2025. https:\/\/www.law.cornell.edu\/uscode\/text\/42\/11302"},{"key":"e_1_3_2_14_2","unstructured":"Homeless Services Department. HMIS links for providers. Accessed September 11 2025. https:\/\/hsd.multco.us\/hmis-links-for-providers"},{"key":"e_1_3_2_15_2","unstructured":"Oregon Health Authority. Oregon death certificate worksheet for funeral homes. 2023. Accessed January 5 2025. https:\/\/www.oregon.gov\/oha\/ph\/birthdeathcertificates\/registervitalrecords\/documents\/death\/deathcertworksheet.pdf"},{"key":"e_1_3_2_16_2","unstructured":"Hodge JGJr Gostin LO; CSTE Advisory Committee. Public Health Practice vs. Research: A Report for Public Health Practitioners Including Cases and Guidance for Making Distinctions. Council of State and Territorial Epidemiologists; 2004. Accessed May 7 2025. https:\/\/ldh.la.gov\/assets\/docs\/IRB\/resources\/Public_Health_Practice_vs_Research.pdf"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1177\/0033354919893032"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/PHH.0000000000001582"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.fsisyn.2024.100468"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/PHH.0000000000001942"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1111\/hsc.13884"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/23780231221121174"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/PHH.0000000000002070"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiac353"},{"key":"e_1_3_2_25_2","unstructured":"Maricopa County Office of the Medical Examiner. Medical Examiner Annual Report 2022. May 2023. Accessed May 7 2025. https:\/\/www.maricopa.gov\/ArchiveCenter\/ViewFile\/Item\/5601"},{"key":"e_1_3_2_26_2","unstructured":"Los Angeles County Department of Public Health Center for Health Impact Evaluation. Mortality rates and causes of death among people experiencing homelessness in LA County: 2017-2023. March 2025. Accessed May 7 2025. http:\/\/publichealth.lacounty.gov\/chie\/reports\/Homeless_Mortality_Report_2025.pdf"},{"key":"e_1_3_2_27_2","unstructured":"Bentley K. Fulton County medical examiner annual report 2022. 2023. Accessed May 7 2025. https:\/\/www.fultoncountyga.gov\/-\/media\/Departments\/Medical-Examiner\/2022-Annual-Report042224medicalexam.pdf"},{"key":"e_1_3_2_28_2","unstructured":"National Health Care for the Homeless Council. Homeless mortality data toolkit: understanding and tracking deaths of people experiencing homelessness. 2021. Accessed May 7 2025. https:\/\/nhchc.org\/wp-content\/uploads\/2020\/12\/Homeless-Mortality-Toolkit-FULL-FINAL.pdf"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.02.077"}],"container-title":["Public Health Reports\u00ae"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00333549251386001","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00333549251386001","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00333549251386001","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T06:35:39Z","timestamp":1785911739000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00333549251386001"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,12]]},"references-count":29,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1177\/00333549251386001"],"URL":"https:\/\/doi.org\/10.1177\/00333549251386001","relation":{},"ISSN":["0033-3549","1468-2877"],"issn-type":[{"value":"0033-3549","type":"print"},{"value":"1468-2877","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,12]]}}}