Disproportionate Increases in Numbers and Rates of Homelessness Among Women in the United States,2018-2022

Abstract

Objectives:

Information about homelessness among women is conflicting. We examined changes in the number and rate of various types of homelessness among females in multiple population groups from 2018 through 2022.

Methods:

We used 5 years of population data (2018-2022) from the US Department of Housing and Urban Development (HUD) and the US Department of Veterans Affairs (VA). We performed descriptive analyses to examine changes in rates of homelessness over time and differences in rates of homelessness between general and veteran populations.

Results:

From 2018 through 2022, there were major increases in rates of unsheltered homelessness among females (25.1%) and males (17.3%) in the general population, which outpaced increases in general population birth rates. Although the percentage change in the proportion of females among all people experiencing unsheltered homelessness grew by 4.0%, the proportion of females among all veterans experiencing unsheltered homelessness grew by 26.3%.

Conclusions:

These findings highlight the growing problem of unsheltered homelessness in the general population. Prevention efforts should be focused particularly on the female, especially veteran female, population.

Keywords

women homelessness veterans unsheltered epidemiology

Homelessness in the United States is a public health problem that has affected more men than women.¹ In recent years, however, women have become one of the fastest-growing segments of the US homeless population.² Many women experiencing homelessness have poor physical health, high rates of psychiatric disorders, and excess mortality rates,^3,4 all of which is also true for men experiencing homelessness.⁵ However, no contemporary examination of rates of female homelessness in various contexts and with various comparison groups has been conducted. For example, it is important to consider the type of homelessness (ie, sheltered vs unsheltered homelessness), subpopulations (eg, veterans), and how rates track with broader population trends (eg, more women in the general population means there will be more women in the population of people experiencing homelessness). Data in the 1990s found that female veterans were at greater risk for homelessness than female nonveterans.⁶ However, it is unclear what type of homelessness was examined in the study, how female veterans compared with male veterans, and whether the same differences also existed between female and male nonveterans. Thus, a comprehensive examination of homeless status among female and male populations is needed.

Both the US Department of Housing and Urban Development (HUD) and the US Department of Veterans Affairs (VA) have dedicated considerable federal resources to address homelessness during the past decade. The VA has been nationally recognized for dramatically reducing homelessness among veterans by halving the number of veterans experiencing homelessness counted in the annual Point-in-Time (PIT) count since 2010, and most of these veterans were male.⁷ However, the reductions made in homelessness may vary by self-identified gender and homeless population.

This study examined a seemingly simple yet complex question: Is homelessness among women increasing? To answer the question, we used data from HUD and VA sources from 2018 through 2022 to examine changes in the number and rate of sheltered and unsheltered homelessness in the general population and in the veteran population in the context of broader population changes.

Methods

We extracted data from 2018 through 2022 on various female and male populations from several sources. Information on the US adult population was based on the American Community Survey 5-year estimates⁸ and US Census estimates for 2022.⁹ Information on the general US veteran population was based on data from the VA National Center for Veterans Analysis and Statistics.¹⁰ Information on general VA service users and VA service users experiencing homelessness was based on an analysis of VA administrative data. General VA service users were veterans enrolled in the VA health care system during the period of interest. Use of any VA homeless services was based on a defined operational definition that includes the continuum of VA homeless programs available.¹¹ Information on unsheltered and sheltered people in the United States and unsheltered and sheltered US veterans was based on HUD’s annual PIT count.⁷ We followed the HUD definition for an individual experiencing homelessness, defined as “a person who is not part of a family with children during an experience of homelessness (ie, the person is not experiencing homelessness in a household with at least one adult and at least one child under age 18.”¹² Of note, the 2021 PIT count of unsheltered people was incomplete because of the COVID-19 pandemic. Because we used population-level data, we directly compared rates instead of relying on statistical inference tests for samples. Because we used public, deidentified aggregate data, the South Texas VA Health Care Institutional Review Board determined that the study did not require ethical or institutional review.

Results

From 2018 through 2022, the average number of sheltered females experiencing homelessness was >150 000, the number of females experiencing unsheltered homelessness was >55 000 (with the exception of 2021), the number of female veterans experiencing sheltered homelessness was >1500, and the number of veterans experiencing unsheltered homelessness was >1400 (with the exception of the 2021 count) (Table 1). Females constituted about 43% to 45% of all people experiencing sheltered homelessness, about 27% to 30% of all people experiencing unsheltered homelessness, about 8% to 9% of veterans experiencing sheltered homelessness, and about 7% to 12% of veterans experiencing unsheltered homelessness (Table 2).

Table 1.

Estimated numbers of different general and homeless female populations in the United States, 2018 through 2022^a

By year	General adult population	General veteran population	General VA service users^b	VA homeless service users	Sheltered homeless people^c	Unsheltered homeless people^c	Sheltered homeless veterans	Unsheltered homeless veterans
Female
2018	127 951 173	1 998 351	719 651	33 735	160 024	56 187	1811	1408
2019	128 908 018	2 014 727	751 394	33 677	157 211	62 700	1798	1494
2020	129 910 794	2 012 760	781 191	31 709	156 681	66 897	1662	1464
2021	130 276 235	2 030 970	803 796	32 208	141 497	14 493	1562	154
2022	132 627 446	2 049 469	831 295	34 846	152 693	70 277	1784	1656
% Change from 2018 to 2022	+3.7	+2.6	+15.5	+3.3	−4.6	+25.1	−1.5	+17.6
Male
2018	121 398 617	18 335 543	7 713 199	233 511	197 025	135 900	21 440	12 972
2019	122 360 385	17 914 068	7 741 650	230 312	197 678	145 509	20 892	12 600
2020	123 361 776	17 385 184	7 746 510	217 508	195 798	156 413	20 324	13 538
2021	125 215 171	16 926 141	7 633 936	214 318	182 673	30 162	18 138	1963
2022	128 209 284	16 542 988	7 565 291	217 074	193 366	159 470	17 705	11 687
% Change from 2018 to 2022	+5.6	−9.8	−1.9	−7.0	−1.9	+17.3	−17.4	−9.9

Abbreviation: VA, US Department of Veterans Affairs.

Data sources: US Department of Housing and Urban Development and US Census Bureau.^7-9 Direct analysis of VA health care data.

General VA service users were based on the number of enrolled veterans in the VA health care system.

Numbers for people experiencing sheltered and unsheltered homelessness were based on the US Department of Housing and Urban Development’s Point-in-Time count, which did not distinguish between children and adults.

Table 2.

Proportion of females among different general and homeless populations in the United States, 2018 through 2022^a

Category	General adult population	General veteran population	General VA service users^b	VA homeless service users	Sheltered homeless people^c	Unsheltered homeless people	Sheltered homeless veterans	Unsheltered homeless veterans
% Female of total population, by year
2018	51.3	9.8	8.5	12.6	44.7	28.9	7.78	9.7
2019	51.3	10.1	8.9	12.8	44.1	29.7	7.9	10.4
2020	51.3	10.4	9.2	12.7	44.2	29.6	7.5	9.6
2021	51.0	10.7	9.5	13.1	43.4	26.6	7.9	6.8
2022	50.9	11.0	9.9	13.8	43.8	30.1	9.1	12.2
% Change in percentage points from 2018 to 2022	−0.5	+1.2	+1.4	+1.2	−0.9	+1.2	+1.4	+2.5
Change in proportion from 2018 to 2022	−0.9	+12.1	+16.0	+9.6	−1.9	+4.0	+17.4	+26.3

Abbreviation: VA, US Department of Veterans Affairs.

Data source: US Department of Housing and Urban Development.⁷

General VA service users were based on the number of enrolled veterans in the VA health care system.

Comparisons With the General Population

From 2018 through 2022, the number of females experiencing unsheltered homelessness increased by 25.1%, whereas the number of females experiencing sheltered homelessness decreased by 4.6% compared with the number of females in the general adult population, which increased by 3.7% (Table 1). The increase in the number of females experiencing unsheltered homelessness was not only disproportionate but had a reverse trend with the declining number of females experiencing sheltered homelessness. From 2018 through 2022, the number of homeless men in the general population experiencing sheltered homelessness also increased by 17.3%. In the general population, the number of men experiencing unsheltered homelessness was at least 2 times larger than the number of females experiencing unsheltered homelessness each year during the study period.

The proportion of females among all people experiencing unsheltered homelessness increased by 1.2 percentage points (or a 4.0% increase) from 2018 to 2022, whereas the proportion of females among the general adult population decreased by 0.5 percentage points (0.9% decrease) (Table 2).

Comparisons With the Veteran Population

We found similar and different trends when we examined female veterans (Figure). From 2018 through 2022, the number of female veterans experiencing unsheltered homelessness increased by 17.6%, and the number of male veterans experiencing unsheltered homelessness decreased by 9.9%. The number of female veterans experiencing sheltered homelessness decreased by 1.5%, and the number of male veterans experiencing sheltered homelessness decreased by 17.4%.

Figure.

Estimated numbers of sheltered homeless females, unsheltered homeless females, and male and female veterans, United States, 2018-2022. Data source: US Department of Housing and Urban Development.⁷

We observed a 2.5 percentage-point increase (or 26.3% increase) in the proportion of females among all veterans experiencing unsheltered homelessness from 2018 to 2022, during which time the proportion of women in the total veteran population increased by 1.2 percentage points (a 12.2% increase). Thus, the growth in the percentage of females among veterans experiencing unsheltered homelessness was more than double the growth in the percentage of females in the total veteran population.

From 2018 through 2022, the number of female veterans using VA homeless services increased by 3.3%, whereas the number of male veterans using VA homeless services decreased by 7.0%. During the same period, the number of female veterans enrolled to use any VA services increased by 15.5% and the number of male veterans who used any VA services decreased by 1.9% (Table 1). Similarly, the proportion of females among VA homeless service users increased by 1.2 percentage points (a 9.6% increase), while the proportion of females among all VA service users increased by 1.4 percentage points (a 16.0% increase) (Table 2).

Discussion

Using 5 years of recent data from HUD and VA, we found that fewer women than men comprised the populations of people experiencing sheltered and unsheltered homelessness. However, although sheltered homelessness among females remained relatively stable during the 5-year period, notable increases occurred in unsheltered homelessness among males and females, and these increases were disproportionate to changes in the general population. For example, from 2018 through 2022, although the proportion of females in the general adult population decreased by 0.9%, the proportion of females among people experiencing unsheltered homelessness increased by 4.0%. This finding is important because people experiencing unsheltered homelessness tend to be homeless for longer periods of time and have more medical, mental health, and psychosocial needs than people experiencing sheltered homelessness.^13,14 We noted the increase in unsheltered homelessness in the general population and in the veteran population; this increase may reflect rising housing costs, lower levels of access to homeless shelters, changing municipal ordinances that allow or prohibit sleeping in public places, and a growing number of homeless encampments in metropolitan US cities.¹³ But we also want to be cautious not to overinterpret the data and infer macroeconomic or social causes for relatively small fluctuations in absolute numbers.

It is also important to consider our findings in the context that 3 of the 5 years of our data overlapped with the COVID-19 pandemic, which was a unique public health event. During the pandemic, many homeless shelters were closed or reduced to minimize virus transmission, which may have increased rates of unsheltered homelessness; concurrently, major federal interventions were implemented, such as eviction moratoria and the emergency rental assistance programs, which may have helped prevent homelessness. Because of these important history effects, we cannot determine whether the gender differences we found were due to the pandemic or will continue beyond the pandemic, stressing the importance of following these gender differences over time with a longer observation period.

Although unsheltered homelessness seems to be a growing problem in general, our data suggest that unsheltered homelessness may be a particular problem among females and especially female veterans, with a larger increase in the number and proportion of females than males among populations of people experiencing unsheltered homelessness. However, of note, the number of females in the general population and female veterans experiencing unsheltered homelessness is small; as such, any changes in numbers tend to result in large changes in percentages. Although our evidence lends support to public concern about rising unsheltered female homelessness, our evidence needs to be understood in the context that females comprise a small percentage of all people experiencing homelessness, and the absolute number of males experiencing unsheltered homelessness was more than double the number of females experiencing unsheltered homelessness from 2018 through 2022.

More females were using VA homeless services than ever before, which is encouraging. However, the increase in the use of VA homeless services among female veterans may largely reflect the increased enrollment in VA services in general. In our study, more female veterans were enrolled in VA health care than ever before; about 830 000 female veterans constituted about 10% of all veterans in the VA system in 2022. In the context of rising rates of unsheltered homelessness among female veterans, the increased use of VA homeless services is lower than the increase in overall enrollment in VA services; as such, greater outreach by VA to female veterans who are experiencing or at risk of experiencing unsheltered homelessness may be warranted. Programs such as the VA’s Health Care for Homeless Veterans are dedicated to providing outreach and linkage to care. Because the VA predominantly serves male veterans, increased attention is needed to ensure that female veterans feel welcome and that services are tailored for them. For example, many community-based transitional housing programs funded by VA are male-dominated environments and may not offer services that meet the needs or preferences of female veterans.¹⁵ Some female veterans experiencing unsheltered homelessness may also have dependent children with them, which requires special housing and social services.¹⁶ Female veterans served by the HUD-VA Supportive Housing program have been successfully and permanently housed through the program¹⁷; thus, policies that support the particular needs of female veterans experiencing homelessness would be important in stemming any tide of increased homelessness in this subgroup.

Limitations

This study had several data analytic limitations. First, because we used population-based numbers, we did not use inferential statistics or statistical testing and instead assumed we had all counts from the populations of interest. The accuracy and reliability of data from the annual PIT count cannot be verified.¹⁸ Second, the PIT count methodology varies by continuums of care, and not all continuums of care participated in the 2021 PIT count of people experiencing unsheltered homelessness as a result of the COVID-19 pandemic; as such, data from that year were incomplete. Third, we did not have comprehensive data on age, race, ethnicity, or geography that would have allowed us to examine how the results varied by demographic characteristics. Further studies are needed using other data to break down how changes in rates of sheltered and unsheltered homelessness vary among different female subgroups and the underlying reasons for these changes that can be addressed with public health intervention.

Conclusions

Data from this study provide contemporary statistics on the problem of homelessness among women in sheltered and unsheltered homelessness populations and among general and veteran populations. Our findings point to a concerning trend of increasing numbers of unsheltered homelessness in the United States overall, and this increase is particularly pronounced among females, particularly female veterans. The recent 5-year trend should continue to be monitored and examined, with interventions ready to be implemented.

Supplemental Material

sj-docx-1-phr-10.1177_00333549241255805 – Supplemental material for Disproportionate Increases in Numbers and Rates of Homelessness Among Women in the United States, 2018-2022

Supplemental material, sj-docx-1-phr-10.1177_00333549241255805 for Disproportionate Increases in Numbers and Rates of Homelessness Among Women in the United States, 2018-2022 by Jack Tsai and Austin Lampros in Public Health Reports®

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Jack Tsai, PhD

Supplemental Material

Supplemental material for this article is available online. The authors have provided these supplemental materials to give readers additional information about their work. These materials have not been edited or formatted by Public Health Reports’s scientific editors and, thus, may not conform to the guidelines of the AMA Manual of Style, 11th Edition.

References

Rossi

PH.

The old homeless and the new homelessness in historical perspective. Am Psychol. 1990;45(8):954-959. doi:10.1037/0003-066x.45.8.954

de Sousa

Andrichik

Cuellar

, et al. The 2022 Annual Homelessness Assessment Report (AHAR) to Congress. US Department of Housing and Urban Development; 2022.

Arangua

Andersen

Gelberg

The health circumstances of homeless women in the United States. Int J Ment Health. 2005;34(2):62-92.

North

Smith

EM.

A comparison of homeless men and women: different populations, different needs. Community Ment Health J. 1993;29(5):423-431. doi:10.1007/BJ00754410

O’Connell

JJ.

Premature Mortality in Homeless Populations: A Review of the Literature. National Health Care for the Homeless Council, Inc; 2005.

Gamache

Rosenheck

Tessler

Overrepresentation of women veterans among homeless women. Am J Public Health. 2003;93(7):1132-1136. doi:10.2105/ajph.93.7.1132

US Department of Housing and Urban Development. Point-in-time count and housing inventory count. 2023. Accessed July 15, 2023. https://www.hudexchange.info/programs/hdx/pit-hic

US Census Bureau. American Community Survey: S0101: age and sex. 2022. Accessed July 20, 2023. https://data.census.gov/table?q=S0101&tid=ACSST5Y2020.S0101

US Census Bureau. National population by characteristics: 2020-2023. 2023. Accessed July 15, 2023. https://www.census.gov/data/datasets/time-series/demo/popest/2020s-national-detail.html

10.

US Department of Veterans Affairs, National Center for Veterans Analysis and Statistics. Veteran population. 2022. Accessed July 15, 2023. https://www.va.gov/vetdata/veteran_population.asp

11.

Tsai

Szymkowiak

Jutkowitz

Developing an operational definition of housing instability and homelessness in Veterans Health Administration’s medical records. PLoS One. 2022;17(12):e0279973. doi:10.1371/journal.pone.0279973

12.

de Sousa

Andrichik

Prestera

Rush

Tano

Wheeler

. The 2023 Annual Homelessness Assessment Report (AHAR) to Congress. US Department of Housing and Urban Development; 2023.

13.

Batko

Oneto

Shroyer

Unsheltered Homelessness: Trends, Characteristics, and Homeless Histories. Urban Institute; 2020.

14.

Kinney

Szymkowiak

Tsai

Growing concern about unsheltered homelessness among veterans: clinical characteristics and engagement in health care services. Public Health Rep. Published online February 7, 2024. doi:10.1177/00333549241227155

15.

Tsai

Rosenheck

McGuire

JF.

Comparison of outcomes of homeless female and male veterans in transitional housing. Community Ment Health J. 2012;48(6):705-710. doi:10.1007/s10597-012-9482-5

16.

Tsai

Kasprow

Kane

Rosenheck

RA.

National comparison of literally homeless male and female VA service users: entry characteristics, clinical needs, and service patterns. Womens Health Issues. 2014;24(1):e29-e35. doi:10.1016/j.whi.2013.09.007

17.

Tsai

Rosenheck

Kane

Homeless female U.S. veterans in a national supported housing program: comparison of individual characteristics and outcomes with male veterans. Psychol Serv. 2014;11(3):309-316. doi:10.1037/a0036323

18.

Tsai

Alarcón

The annual homeless point-in-time count: limitations and two different solutions. Am J Public Health. 2022;112(4):633-637. doi:10.2105/AJPH.2021.306640

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.06 MB