In Reply We would like to thank Xu and colleagues for writing such a thoughtful response to our article¹ on the prevalence of addictions and mental health (AMH) disorders among people experiencing homelessness (PEH). We agree with the perspectives expressed in their letter and appreciate the opportunity to respond to their comments.

First, we acknowledge the limitations of our study design. Our meta-analysis is a synthesis of the reported prevalence of AMH among PEH using data from cross-sectional studies. As AMH and homelessness were measured at the same time in these cross-sectional studies, it is difficult to establish temporal relationships² between AMH and homelessness. This makes it challenging to interpret the high prevalence of some conditions observed in our study such as antisocial personality disorder (ASPD). Xu and colleagues correctly highlight the significance that health equity may play in this relationship, and it is possible that underlying structural inequities are contributing to the high prevalence of ASPD reported in the individual studies included in our review. Due to the constraints inherent in the study design of cross-sectional studies, we cannot account for structural racism, prior incarceration, health care access, or sociopolitical determinants of health that we agree likely play an important role underlying the high prevalence of ASPD in our review.