Abstract
BACKGROUND: 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. OBJECTIVE: 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. DESIGN: 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. PARTICIPANTS: Adults with an encounter at a MNEHRC-participating health system between 2021-2023. MAIN MEASURES: 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. KEY RESULTS: 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. CONCLUSIONS: 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.