Background <p>Homelessness is a growing crisis consistently linked to adverse health. At the same time, race is strongly associated with homelessness risk. Thus, understanding and addressing racial disparities in homelessness is imperative for health equity. This study explores geographic variation in Black-to-White disparities in homelessness across the United States and examines how measures of local structural racism are associated with these inequities.</p> Methods <p>The study sample included 259 urban and suburban communities. The dataset was constructed by merging estimates of sheltered, unsheltered, and family homelessness from the U.S. Department of Housing and Urban Development with community-level housing, economic, criminal justice, education, and demographic characteristics, Black-White disparities in these domains, and a multidimensional measure of structural racism. Black-to-White homelessness rate ratios were calculated to describe disparities across communities, and linear regression models were used to test associations with structural racism.</p> Results <p>Black people were five times as likely to experience homelessness than White people, with Black families with children eleven times as likely. Regression results showed that Black-White disparities were positively associated with a measure of structural racism that accounted for housing, economic, education, and criminal justice inequities. In multivariate models examining distinct domains, disparities in homelessness were uniquely associated with disparities in criminal justice (jailing ratio), housing (renter share ratio), and poverty.</p> Conclusion <p>Black-White disparities in homelessness are consistently high but vary in severity across communities. This variation is strongly associated with a quantitative measure of structural racism, providing evidence that addressing structural racism is key to preventing and ending homelessness and the health disparities associated with it.</p>