Morbidity and mortality in a prospective cohort of people who were homeless during the COVID-19 pandemic

Abstract

IntroductionCertain living conditions, such as homelessness, increase health risks in epidemic situations. We conducted a prospective observational cohort study to investigate the impact of the COVID-19 pandemic on morbidity and mortality in adult people who were homeless.MethodsThe study population comprised around 40% of the entire population experiencing homelessness in Marseille. They were enrolled at 48 different locations during the first pandemic wave (June to August 2020) and were followed up 3 and 6 months later. Rapid serological screening for SARS-CoV-2 was performed by community outreach teams at each follow-up, who also conducted interviews. Death registers and hospital administrative databases were consulted.ResultsA total of 1,332 participants [mean age 40.1 years [SD 14.2], women 339 (29.9%)] were enrolled in the cohort. Of these, 192 (14.4%) participants were found positive for COVID-19 and were propensity score matched (1:3) and compared with 553 non-COVID-19 cases. Living in emergency shelters was associated with COVID-19 infection. While 56.3% of the COVID-19-infected cohort reported no symptoms, 25.0% were hospitalized due to the severity of the disease. Presence of three or more pre-existing comorbidities was associated with all-cause hospitalization. Among COVID-19 cases, only older age was associated with COVID-19 hospitalization. Three deaths occurred in the cohort, two of which were among the COVID-19 cases.ConclusionThe study provides new evidence that the population experiencing homelessness faces higher risks of infection and hospitalization due to COVID-19 than the general population. Despite the efforts of public authorities, the health inequities experienced by people who are homeless remained major. More intensive and appropriate integrated care and earlier re-housing are needed.

Respiratory Syncytial Virus, Influenza and SARS-CoV-2 in Homeless People from Urban Shelters: A Systematic Review and Meta-Analysis (2023)

“…A total of 102 articles were therefore full-text-reviewed; of them, 66 were removed from the analyses as they were not consistent with the research topic, while 3 further reports were removed for not fulfilling the inclusion criteria, and 2 reports were removed for including cases otherwise described in other studies [19][20][21]96,97]. The final sample included a total of 31 studies (0.62% of the initial sample); of them, 17 were prevalence studies [4][5][6]17,18,42,[98][99][100][101][102][103][104][105][106][107][108], 12 studies reported on the incidence of respiratory pathogens [19][20][21]44,[109][110][111][112][113][114][115][116] and the remaining 2 studies reported on the outcome of respiratory infections in HP [117,118]. As two incidence studies also included outcome data, a total of four outcome studies were ultimately retrieved [19,112].…”

“…A total of four outcome studies were retrieved. Two of them included data collected from the Seattle area [19,117], while the remaining papers detailed cases from Toronto [112] and Marseille [118] (one study each). Two reports included data on both HP and the general population, for a total of 32,091 HP and 1,576,936 non-HP [117,118].…”

“…Two of them included data collected from the Seattle area [19,117], while the remaining papers detailed cases from Toronto [112] and Marseille [118] (one study each). Two reports included data on both HP and the general population, for a total of 32,091 HP and 1,576,936 non-HP [117,118]. Regarding the two remaining studies, Loubiere et al [118] reported on a total of 1332 HP tested for SARS-CoV-2 infection, while the study from Rogers et al [19] included data on about 649 HP drawn from the larger population of HP in the King's County area, otherwise included in other incidence studies.…”

“…Two reports included data on both HP and the general population, for a total of 32,091 HP and 1,576,936 non-HP [117,118]. Regarding the two remaining studies, Loubiere et al [118] reported on a total of 1332 HP tested for SARS-CoV-2 infection, while the study from Rogers et al [19] included data on about 649 HP drawn from the larger population of HP in the King's County area, otherwise included in other incidence studies. Three studies included data about the hospitalizations of the sampled individuals, while the study by Rogers et al [19] only included data about people who sought healthcare advice following respiratory infections.…”

“…Focusing on the reported pathogens, the studies by Boonyaratanakornkit et al [117] and Rogers et al [19] included data about RSV and influenza infections, while the studies by Loubiere et al [118] and Richard et al [112] only included diagnoses of SARS-CoV-2 infections.…”