Characteristics of injury deaths among homeless and non-homeless US veterans (2017-2021).

Objective: The objective of this study is to assess whether experiencing homelessness may be associated with future risk of injury death and characterise these injury deaths by homelessness status among veterans who received healthcare through the US Department of Veterans Affairs (VA).

Methods: A retrospective cohort study was conducted among 6 128 921 veterans (399 125 homeless and 5 729 796 non-homeless) who received VA healthcare between 2017 and 2020 and were followed until 2021 using linked data from VA's Corporate Data Warehouse, Homeless Operations Management System and the VA/Department of Defense Joint Mortality Data Repository. Injury death rates were estimated by homelessness status with 95% CIs using the exact Poisson method. Multivariable Cox regression models were applied to estimate HRs with 95% CI for homelessness as a predictor of injury deaths, controlling for demographic, clinical, substance use and mental health characteristics.

Results: The injury-specific mortality rate (per 100 000 person-years) was estimated at 254.4 (95% CI 252.5 to 256.4) and was higher among homeless (453.3 (95% CI 443.3 to 463.5)) versus non-homeless (239.9 (95% CI 237.9 to 241.9)) veterans. There were disparities in anatomical sites and injury type by homelessness status. Injury-related risk of death was twice as high among veterans with versus without a homelessness experience (adjusted HR 1.93, 95% CI 1.88 to 1.98).

Conclusion: Homeless veterans may be at high risk for specific patterns of injury death. Injury prevention efforts should target exposures that distinguish this vulnerable population from other veterans seeking VA healthcare services.