Did people experiencing homelessness have worse in-hospital outcomes from COVID-19 than housed people?

Research published in the Canadian Medical Association Journal found no differences in in-hospital deaths or hospital admission rates for people experiencing homelessness (PEH) who visited hospital for acute COVID-19 symptoms.

“In our study, we sought to answer the question of whether experiencing homelessness is a risk factor for worse prognosis from COVID-19 illness independent of important clinical variables including age, comorbidities, vaccination status, and substance use—i.e., whether clinicians should have a lower threshold for admission or other treatments for patients with COVID-19 based on housing status alone,” writes Dr. Siying Shari Li, an emergency medicine physician, University of British Columbia, with co-authors.

The study included data from the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) on visits to 50 emergency departments in eight provinces from March 1, 2020, onwards. People experiencing homelessness were identified as “having no fixed address” or from a shelter, and housed people were described as arriving from home or single occupancy.

They did not include residents of institutions, visitors, or people arriving from hotels.

The researchers found no difference in hospital admission rates or death rates between people experiencing homelessness and housed patients. However, the former were less likely to be admitted to the intensive care unit or to be intubated.

“[This] raises the question of whether there may have been differential treatment for reasons unrelated to matched clinical characteristics. Future research could explore inequities in health care resource allocation, especially in times of scarcity, as well as interventions targeting transmission among PEH,” the researchers conclude.

Research published in the Canadian Medical Association Journal found no differences in in-hospital deaths or hospital admission rates for people experiencing homelessness (PEH) who visited hospital for acute COVID-19 symptoms.

“In our study, we sought to answer the question of whether experiencing homelessness is a risk factor for worse prognosis from COVID-19 illness independent of important clinical variables including age, comorbidities, vaccination status, and substance use—i.e., whether clinicians should have a lower threshold for admission or other treatments for patients with COVID-19 based on housing status alone,” writes Dr. Siying Shari Li, an emergency medicine physician, University of British Columbia, with co-authors.

The study included data from the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) on visits to 50 emergency departments in eight provinces from March 1, 2020, onwards. People experiencing homelessness were identified as “having no fixed address” or from a shelter, and housed people were described as arriving from home or single occupancy.

They did not include residents of institutions, visitors, or people arriving from hotels.

The researchers found no difference in hospital admission rates or death rates between people experiencing homelessness and housed patients. However, the former were less likely to be admitted to the intensive care unit or to be intubated.

“[This] raises the question of whether there may have been differential treatment for reasons unrelated to matched clinical characteristics. Future research could explore inequities in health care resource allocation, especially in times of scarcity, as well as interventions targeting transmission among PEH,” the researchers conclude.