Our Research

Existing literature on people experiencing homelessness (PEH) draws on non-representative samples from service providers, populations with comorbidities, or areas with disproportionately high sheltered homelessness, leading to bias. Nearly a third of PEH in the US and over half of unsheltered PEH live in California. Researchers from the UCSF Benioff Homelessness and Housing Initiative designed a rigorous state-representative survey of PEH to investigate the antecedents of homelessness, understand health, and inform policy solutions. This is the first large representative study of PEH, beyond a single county, to draw inference on a large population that did not depend on service utilization.

Before medically advised (BMA) discharge is associated with higher rates of readmission and death in other settings. In this study, researchers used multivariable logistic regression to evaluate the association between housing status and BMA discharge. Researchers found that BMA discharge is more common in patients experiencing homelessness after surgery even after adjusting for observable confounding characteristics. A deeper understanding of the drivers of BMA discharge in patients experiencing homelessness through qualitative methods is critical to promoting more equitable and effective care.

Depression is common in adults experiencing homelessness. In this cohort study, researchers examined the association between residential status and depressive symptoms in adults 50 years or older experiencing homelessness. Researchers found that continued homelessness was associated independently with increased odds of depressive symptoms.

Intimate partner violence (IPV) is a risk factor for people experiencing homelessness. Few studies have examined the interplay between IPV, homelessness, and housing. Researchers purposefully sampled 104 adults who reported experiencing IPV in the California Statewide Study of People Experiencing Homelessness (CASPEH), a representative, mixed-methods study. They identified six primary themes regarding IPV and homelessness.

Homelessness is associated with poor outcomes following cancer diagnosis. In this retrospective cohort study, researchers examined the association between housing status and acute care in adult patients treated for cancer at Zuckerberg San Francisco General Hospital. Researchers found that among patients receiving treatment for cancer at an urban public hospital, acute care use increased disproportionately in unhoused patients in the year of diagnosis, while psychiatric acute care use did not change.

People experiencing homelessness have worse mental and physical health than the general population. They also have limited access to primary care for reasons including the absence of health insurance, lack of money for co-payments or transportation, and communication barriers. In this JAMA Insights, researchers examine the adverse effects of homelessness on physical and mental health and suggest strategies to improve access to care.

Before medically advised (BMA) discharge, which refers to patients leaving the hospital at their own discretion, is associated with higher rates of readmission and death in other settings. There is limited information on whether housing status is associated with BMA after surgery. This study used multivariable logistic regression to evaluate the association between housing status and BMA discharge. Researchers found that BMA discharge is more common in patients experiencing homelessness after surgery.

Traumatic injury is a leading cause of hospitalization among people experiencing homelessness. In this retrospective cohort study of the American College of Surgeons Trauma Quality Programs (TQP) researchers evaluated whether homelessness was associated with increased morbidity and length of stay (LOS) after hospitalization for traumatic injury. Researchers found that challenges in providing safe discharge to people experiencing homelessness after injury may lead to prolonged LOS.

Loneliness is often more common in older adults and those who face structural vulnerabilities, including those who experience homelessness. In the United States, 48% of single homeless adults are 50 and older. There is a limited information about loneliness among older adults who have experienced homelessness. This study used qualitative data collected as part of a longitudinal mixed-methods study, Health Outcomes of People Experiencing Homelessness in Older Middle Age (HOPE HOME). The study aimed to examine the intersection between social isolation, functional and cognitive impairment, and use of supportive services among a cohort of older adults experiencing homelessness in Oakland, California. Researchers found that homeless-experienced older adults with cognitive or functional impairments exhibited diverse loneliness experiences.

On a single night in 2023, more than 653,000 people experienced homelessness in the United States. In this overview, researchers highlight the structural and individual risk factors that lead to homelessness, explore evidence on the relationship between homelessness and health, discuss programmatic and policy innovations, and provide policy recommendations.

Cancer is a leading cause of death in older unhoused adults. In this retrospective cohort study, researchers assessed whether being unhoused, gaining housing, or losing housing in the year after cancer diagnosis is associated with poorer survival compared with being continuously housed. Researchers used a national sample of veterans with lung, colorectal, and breast cancer during the period of 2011-2020. Findings showed veterans who were unhoused before and for the twelve months after their diagnosis had 10–20 percent greater risk for all-cause mortality than veterans who were consistently housed, even after adjustment for multiple factors.