Prognosis of people experiencing homelessness who are diagnosed with covid-19

Background: People experiencing homelessness (PEH) are at higher risk for many negative health outcomes. It is unclear whether, or to what extent, this is the case for outcomes for PEH from COVID-19 compared with housed individuals. Specifically, there remains equipoise whether PEH with COVID-19 have different risk for in-hospital mortality, hospital admission, critical care admission, and intubation. Methods: A scoping review identified existing literature on PEH and COVID-19 outcomes. After a search of EMBASE and MEDLINE, eligible studies were tabulated and summarized in narrative form. A propensity score matched cohort study utilizing data from the CCEDRRN registry compared PEH with housed individuals presenting to emergency departments (EDs) for acute symptomatic COVID-19. Covariates in the propensity score model include age, sex, comorbidities, substance use, vaccination status, prior do not resuscitate documentation, hospital type, province and calendar quarter of ED presentation, symptom duration, and severity of illness on presentation. Logistic regression compared risk for our outcomes across the propensity matched cohorts, adjusting for the same covariates as in the propensity score model. Results: The scoping review found sparse research on PEH outcomes from COVID-19, with contradictory findings and significant methodological limitations across studies. In propensity sore matched analyses, there was no difference in mortality for PEH (3%) compared with housed patients (3%) (OR 0.87, 95% CI 0.43 to 1.74, p=0.69). There was no difference in admission rates for PEH (44%) versus housed patients (45%). There was a reduced rate of critical care admission for PEH versus housed patients (OR 0.66, 95% CI 0.44 to 1.00, p<0.05), and a trend towards decreased intubation for PEH versus housed patients which was not significant (OR 0.60, 95% CI 0.35 to 1.02, p=0.06). Conclusion: Prior research on COVID-19 outcomes in PEH has been limited. In our propensity score matched analysis, there was no difference in mortality for PEH with COVID-19; however, findings of reduced critical care admission among PEH suggest differential treatment unrelated to clinical characteristics which were matched for. Future research on resource allocation during pandemics could shed light on potential inequities for vulnerable populations including PEH and the most effective ways to address them.