Association Between Housing Status and COVID-19 Severity, Morbidity, and Mortality in the United States: A Propensity Score-Matched Analysis of the National Inpatient Sample

The influence of unstable housing on COVID-19 health outcomes remains inadequately elucidated in existing literature. Prevailing assumptions suggest that individuals with unstable housing are more likely to have limited access to healthcare services, exacerbated comorbid conditions, and suboptimal living environments. Utilizing the 2020 National Inpatient Sample, we conducted a retrospective analysis on a cohort of 3838305 patients diagnosed with COVID-19. Of these, 22550 (0.59%) were identified as residing under unstable housing conditions. Both multivariate regression and propensity score-matched analyses were employed to evaluate key outcomes: in-hospital mortality, complications, hospitalization charges, length of stay, and disposition statuses. Contrary to the extant literature on infectious diseases, our analysis unveiled that patients with unstable housing conditions had lower rates of in-hospital mortality and fewer complications compared to those with stable housing. Notwithstanding, the propensity of this subgroup to leave against medical advice poses unique challenges and introduces the potential for adverse outcomes. While the findings contribute nuanced perspectives, it is imperative to recognize that unstable housing continues to be a significant determinant of a constellation of long-term health issues, such as mental health disorders, substance use, and chronic illnesses. Consequently, targeted interventions are indispensable for enhancing the health trajectory of this vulnerable population, especially in the exigencies of the COVID-19 pandemic.