People Experiencing Homelessness Found to Have Less COVID-19 Incidence Than General Population

The COVID-19 pandemic impacted people experiencing homeless, though estimates remain unknown and highlights a need for more inclusive data.

People experiencing homeless (PEH) had fewer total COVID-19 cases and incidence rates than the general population at state, district, and local levels, according to a cross-sectional study published in JAMA. Researchers evaluated primary outcomes for the number of PEH COVID-19 cases and compared incidence rates of COVID-19 cases between PEH and the general population of a shared geographical area.

Although PEH experienced these lower rates, the results show that PEH should be considered in future infectious disease surveillance to understand how it affects marginalized groups, according to the investigators.

“The findings suggest that opportunities exist for incorporating housing and homelessness status in infectious disease reporting to inform public health decision-making,” said study lead, Ashley Meehan, in a press release.

PEH have a greater risk to contract infectious diseases, have behavioral health issues, and face chronic health conditions, according to the study. The crowds and turnover of homeless shelters creates an adequate environment for the spread of COVID-19. Although homeless shelters experienced severe outbreaks of COVID-19 during the first 6 months, researchers still do not fully understand how the disease impacted PEH.

Limited timely and high-quality data for total cases of COVID-19 among PEH led researchers to conduct a cross-sectional study. The study authors aimed to estimate the number of COVID-19 cases among PEH and compare the incidence rate with the general population to better inform prevention recommendations and care for this population.

Researchers gathered data for a population-based sample of 64 US jurisdictional health departments. In total, 25 states, districts, and territories completed the survey, which was issued by the Centers for Disease Control and Prevention between January 1, 2021, and September 30, 2021. They surveyed a wide range of diverse racial and ethnic groups. White PEH made up the majority, followed by Black PEH.

The results of the state and district level surveys reported 26,349 COVID-19 cases among PEH. On the local level, 20,487 COVID-19 cases were reported.

The incidence rate of state-level COVID-19 cases in PEH was 567 per 10,000 person-years. The general population experienced 715 COVID-19 cases per 10,000 person-years.

Locally, COVID-19 incidence rate just more than 799 per 10,000 person-years in PEH v 812 per 10,000 person-years in the general population.

Approximately 50% of US states collected PEH data. It is limited representation for all US geographical areas and does not account for the total number of PEH. The study was also limited in the duration of homelessness, ability to verify homeless status, data viability, and seasonal/climate impact on COVID-19 cases.

The findings further establish that future studies could be done to identify the varying degrees of homelessness, what individuals define as homelessness, and how this population can impact future public health services, according to the study authors.

“Integration of these data systems may alleviate burden on health departments in collecting housing or homelessness information during case investigations or interviews and would further support ongoing data modernization initiatives,” the authors concluded in the journal.

Reference

Meehan, Ashley, Thomas, Isabel, Horter, Libby, et al. Incidence of COVID-19 Among Persons Experiencing Homelessness in the US From January 2020 to November 2021. JAMA Netw Open. 2022;5(8): e2227248. doi:10.1001/jamanetworkopen.2022.27248. August 18, 2022. Accessed on August 19, 2022.