Characterizing Violent Fatalities Among People Experiencing Homelessness Using the National Violent Death Reporting System, 2010 to 2021

Homelessness continues to be a serious public health problem in the United States. People experiencing homelessness (PEH) face stark health inequities, including high mortality rates and increased risk of violence victimization. Little is known about the risk factors around PEH dying violently. The objective of this study is to comprehensively describe these fatalities to inform future research and prevention efforts for this population. This retrospective study utilized data from the National Violent Death Reporting System from 2010 to 2021 to characterize and compare fatalities among PEH versus people who were not experiencing homelessness (PNEH). This study identified 7,231 PEH and 423,363 PNEH victims. Among PEH, the most common manners of death were suicide (44.9%) and homicide (31.0%), most were male (83.0%), and White, non-Hispanic (59.3%). Compared to PNEH, a significantly greater proportion of PEH had an alcohol problem (26.9% vs. 15.2%; <i>p</i> < .001) or other substance use problem (48.8% vs. 19.6%; <i>p</i> < .001). Among decedents who had a current mental health problem (PEH: 33.6% vs. PNEH: 36.7%), a smaller percentage of PEH were currently receiving treatment (PEH: 13.9% vs. PNEH: 20.7%; <i>p</i><.001). Among those who died by suicide, more PEH had a recent eviction/loss of home that contributed to the death, compared to PNEH (21.0% vs. 2.8%; <i>p</i> < .001). Among individuals who died by homicide, PEH were significantly more likely to be killed by a random act of violence (PEH: 5.1% vs. PNEH: 2.6%; <i>p</i> < .001). These findings highlight unique characteristics of violent deaths among PEH, including circumstances involving mental health and substance use problems, and identify key intervention points for suicide prevention among this population. Future research to help prevent violence-related deaths among PEH would benefit by improved data collection methods to reduce missing data and linkages with other data sources.