Zellmer Lucas, Van Siclen Renee, Bodurtha Peter, Drawz Paul E, Waring Stephen C, Chamberlain Alanna M, Sabayan Behnam, Johnson Steven G, Margolis Karen, Rossom Rebecca, Vickery Katherine Diaz, Winkelman Tyler N A
Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, USA.
Hospital Medicine, Fairview Health Services, Minneapolis, MN, USA.
J Gen Intern Med. 2025 Sep 2. doi: 10.1007/s11606-025-09814-x.
Public health data systems have limited ability to provide timely, population-level information for people with severe and multiple disadvantages, such as individuals with recent homelessness or incarceration.
To generate prevalence estimates for physical health, mental health, and substance use conditions in a statewide cohort that included individuals with recent incarceration or homelessness.
This observational cohort analysis was completed in July 2025 and used linked statewide electronic health record (EHR) and administrative data through the Minnesota Electronic Health Record Consortium (MNEHRC) and its Health Trends Across Communities project.
Adults with an encounter at a MNEHRC-participating health system between 2021-2023.
Statewide directly standardized, age and sex-adjusted, prevalence rates of 22 health conditions chosen by public health, healthcare, and research leaders in Minnesota, stratified by recent homelessness, jail incarceration, or prison incarceration.
This cohort included 4,362,645 individuals (53% female, 73% white), including 20,139 individuals with recent homelessness, 51,470 individuals with recent jail incarceration, and 4,889 individuals with recent prison incarceration. Individuals with recent homelessness or jail or prison incarceration had a higher prevalence of asthma (14.9%, 9.6%, 10.1% respectively, vs. 7.1%) and COPD (10.5%, 6.1%, 5.5%, respectively, vs. 3.0%) compared to the general population. Individuals with recent homelessness had the highest rates of mental health disorders compared to other included groups; recently homeless Black individuals had the highest recorded rates of psychotic disorder diagnoses (18.7%) across racial and ethnic groups experiencing homelessness. Substance use disorders among individuals with recent homelessness or jail or prison incarceration, including opioid use disorder (13.9%, 10.6%, and 13.6%, respectively, vs. 1.4%), were higher compared to the general population.
Our findings highlight widespread disparities among people with recent homelessness or incarceration, particularly related to mental health and substance use conditions. Payment and delivery models that account for high levels of co-occurring health and social complexity are needed.
公共卫生数据系统在为有严重和多重不利因素的人群（如近期无家可归或被监禁的个人）提供及时的、人群层面信息方面能力有限。
对一个全州范围队列中身体健康、心理健康和物质使用状况的患病率进行估计，该队列包括近期被监禁或无家可归的个人。
这项观察性队列分析于2025年7月完成，通过明尼苏达电子健康记录联盟（MNEHRC）及其跨社区健康趋势项目，使用了全州范围相链接的电子健康记录（EHR）和行政数据。
2021年至2023年间在参与MNEHRC的医疗系统中有就诊经历的成年人。
由明尼苏达州公共卫生、医疗保健和研究领域的领导者选定的22种健康状况的全州直接标准化、年龄和性别调整后的患病率，按近期无家可归归归、入狱或监禁进行分层。
该队列包括4362645人（53%为女性，73%为白人），其中包括20139名近期无家可归者、51470名近期入狱者和4889名近期被监禁者。与普通人群相比，近期无家可归者、入狱者或被监禁者患哮喘（分别为14.9%、9.6%、10.1%，而普通人群为7.1%）和慢性阻塞性肺疾病（分别为10.5%、6.1%、5.5%，而普通人群为3.0%）的患病率更高。与其他纳入组相比，近期无家可归者的心理健康障碍发生率最高；在经历无家可归的种族和族裔群体中，近期无家可归的黑人个体精神病性障碍诊断记录率最高（18.7%）。与普通人群相比，近期无家可归者、入狱者或被监禁者的物质使用障碍发生率更高，包括阿片类物质使用障碍（分别为13.9%、10.6%和13.6%，而普通人群为1.4%）。
我们的研究结果凸显了近期无家可归者或被监禁者之间广泛存在的差异，特别是与心理健康和物质使用状况相关的差异。需要有考虑到高度并存的健康和社会复杂性的支付和服务模式。
