Describing Utilization of Health Care and Diagnoses Before Deaths in Homelessness: Leveraging Health Information Exchange and Medicolegal Partnerships, Harris County, Texas, 2021-2023.

Objectives. To describe health care utilization and diagnostic patterns among adults who died while experiencing homelessness in Harris County, Texas, using linked medicolegal and health information exchange (HIE) data. Methods. Decedent records from the medical examiner (2021-2023) were linked to data from the regional HIE. Demographics, causes of death, health care encounters within 12 months of death, and diagnoses were summarized descriptively. Results. Among 659 decedents, deaths rose from 179 in 2021 to 242 in 2023, despite stable point-in-time counts of homelessness. More than half (58%) had recent health care encounters, with utilization rising sharply in the final 3 months of life. Outpatient visits were the most common, and mental and behavioral disorders predominated across all settings. Toxicity and cardiovascular disease were the leading causes of death. Conclusions. Deaths among people experiencing homelessness rose despite continual and escalating health care contacts before death, providing context for identifying potential prevention strategies. Linking medicolegal and clinical data offers a replicable model for local surveillance and supports targeted interventions integrating harm reduction, behavioral health, and continuity of care. (Am J Public Health. Published online ahead of print October 1, 2026:e1-e9. https://doi.org/10.2105/AJPH.2026.308630).