Hospitalizations During the COVID-19 Pandemic Among Recently Homeless Individuals: a Retrospective Population-Based Matched Cohort Study.
J Gen Intern Med
; 37(8): 2016-2025, 2022 06.
Article
in English
| MEDLINE | ID: covidwho-1782930
ABSTRACT
BACKGROUND:
Hospitalizations fell precipitously among the general population during the COVID-19 pandemic. It remains unclear whether individuals experiencing homelessness experienced similar reductions.OBJECTIVE:
To examine how overall and cause-specific hospitalizations changed among individuals with a recent history of homelessness (IRHH) and their housed counterparts during the first wave of the COVID-19 pandemic, using corresponding weeks in 2019 as a historical control.DESIGN:
Population-based cohort study conducted in Ontario, Canada, between September 30, 2018, and September 26, 2020.PARTICIPANTS:
In total, 38,617 IRHH, 15,022,368 housed individuals, and 186,858 low-income housed individuals matched on age, sex, rurality, and comorbidity burden. MAINMEASURES:
Primary outcomes included medical-surgical, non-elective (overall and cause-specific), elective surgical, and psychiatric hospital admissions. KEYRESULTS:
Average rates of medical-surgical (rate ratio 3.8, 95% CI 3.7-3.8), non-elective (10.3, 95% CI 10.1-10.4), and psychiatric admissions (128.1, 95% CI 126.1-130.1) between January and September 2020 were substantially higher among IRHH compared to housed individuals. During the peak period (March 17 to June 16, 2020), rates of medical-surgical (0.47, 95% CI 0.47-0.47), non-elective (0.80, 95% CI 0.79-0.80), and psychiatric admissions (0.86, 95% CI 0.84-0.88) were significantly lower among housed individuals relative to equivalent weeks in 2019. No significant changes were observed among IRHH. During the re-opening period (June 17-September 26, 2020), rates of non-elective hospitalizations for liver disease (1.41, 95% CI 1.23-1.69), kidney disease (1.29, 95% CI 1.14-1.47), and trauma (1.19, 95% CI 1.07-1.32) increased substantially among IRHH but not housed individuals. Distinct hospitalization patterns were observed among IRHH even in comparison with more medically and socially vulnerable matched housed individuals.CONCLUSIONS:
Persistence in overall hospital admissions and increases in non-elective hospitalizations for liver disease, kidney disease, and trauma indicate that the COVID-19 pandemic presented unique challenges for recently homeless individuals. Health systems must better address the needs of this population during public health crises.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Ill-Housed Persons
/
COVID-19
Type of study:
Cohort study
/
Observational study
/
Prognostic study
/
Qualitative research
Limits:
Humans
Country/Region as subject:
North America
Language:
English
Journal:
J Gen Intern Med
Journal subject:
Internal Medicine
Year:
2022
Document Type:
Article
Affiliation country:
S11606-022-07506-4
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