Hospitalizations for COVID-19 Among US People Experiencing Incarceration or Homelessness | Infectious Diseases | JN Learning | AMA Ed Hub [Skip to Content]
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Key Points

Question  How do COVID-19 hospitalizations for people experiencing incarceration or homelessness compare with those among the general US population?

Findings  In a cross-sectional study using hospital discharge records from more than 800 hospitals, people experiencing incarceration who were evaluated in the emergency department had a higher frequency of hospitalization, invasive mechanical ventilation, mortality, and readmissions, as well as longer lengths of stay, compared with the general population. People experiencing homelessness who were evaluated in the emergency department had a higher frequency of hospitalization and readmissions, a lower frequency of invasive mechanical ventilation and mortality, and longer lengths of stay compared with the general population.

Meaning  This study suggests that expanding medical respite may reduce hospitalizations or shorten the length of stay for COVID-19 for people experiencing incarceration or homelessness who are disproportionately affected by the pandemic.


Importance  People experiencing incarceration (PEI) and people experiencing homelessness (PEH) have an increased risk of COVID-19 exposure from congregate living, but data on their hospitalization course compared with that of the general population are limited.

Objective  To compare COVID-19 hospitalizations for PEI and PEH with hospitalizations among the general population.

Design, Setting, and Participants  This cross-sectional analysis used data from the Premier Healthcare Database on 3415 PEI and 9434 PEH who were evaluated in the emergency department or were hospitalized in more than 800 US hospitals for COVID-19 from April 1, 2020, to June 30, 2021.

Exposures  Incarceration or homelessness.

Main Outcomes and Measures  Hospitalization proportions were calculated. and outcomes (intensive care unit admission, invasive mechanical ventilation [IMV], mortality, length of stay, and readmissions) among PEI and PEH were compared with outcomes for all patients with COVID-19 (not PEI or PEH). Multivariable regression was used to adjust for potential confounders.

Results  In total, 3415 PEI (2952 men [86.4%]; mean [SD] age, 50.8 [15.7] years) and 9434 PEH (6776 men [71.8%]; mean [SD] age, 50.1 [14.5] years) were evaluated in the emergency department for COVID-19 and were hospitalized more often (2170 of 3415 [63.5%] PEI; 6088 of 9434 [64.5%] PEH) than the general population (624 470 of 1 257 250 [49.7%]) (P < .001). Both PEI and PEH hospitalized for COVID-19 were more likely to be younger, male, and non-Hispanic Black than the general population. Hospitalized PEI had a higher frequency of IMV (410 [18.9%]; adjusted risk ratio [aRR], 1.16; 95% CI, 1.04-1.30) and mortality (308 [14.2%]; aRR, 1.28; 95% CI, 1.11-1.47) than the general population (IMV, 88 897 [14.2%]; mortality, 84 725 [13.6%]). Hospitalized PEH had a lower frequency of IMV (606 [10.0%]; aRR, 0.64; 95% CI, 0.58-0.70) and mortality (330 [5.4%]; aRR, 0.53; 95% CI, 0.47-0.59) than the general population. Both PEI and PEH had longer mean (SD) lengths of stay (PEI, 9 [10] days; PEH, 11 [26] days) and a higher frequency of readmission (PEI, 128 [5.9%]; PEH, 519 [8.5%]) than the general population (mean [SD] length of stay, 8 [10] days; readmission, 28 493 [4.6%]).

Conclusions and Relevance  In this cross-sectional study, a higher frequency of COVID-19 hospitalizations for PEI and PEH underscored the importance of adhering to recommended prevention measures. Expanding medical respite may reduce hospitalizations in these disproportionately affected populations.

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Article Information

Accepted for Publication: November 17, 2021.

Published: January 13, 2022. doi:10.1001/jamanetworkopen.2021.43407

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Montgomery MP et al. JAMA Network Open.

Corresponding Author: Martha P. Montgomery, MD, MHS, COVID-19 Emergency Response, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS US12-3, Atlanta, GA 30329 (

Author Contributions: Dr Montgomery had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Montgomery, Clarke, Fields, Schieber, Kompaniyets, Lambert, Mosites.

Acquisition, analysis, or interpretation of data: Montgomery, Hong, Clarke, Williams, Fukunaga, Park, Schieber, Kompaniyets, C. M. Ray, D’Inverno, T. K. Ray, Jeffers, Mosites.

Drafting of the manuscript: Montgomery, Fukunaga, Lambert, Jeffers.

Critical revision of the manuscript for important intellectual content: Montgomery, Hong, Clarke, Williams, Fukunaga, Fields, Park, Schieber, Kompaniyets, C. M. Ray, D’Inverno, T. K. Ray, Mosites.

Statistical analysis: Hong, Fukunaga, Park, Schieber, Kompaniyets, T. K. Ray, Jeffers.

Administrative, technical, or material support: Montgomery, Hong, Clarke, Williams, Fukunaga, Kompaniyets, Lambert, D’Inverno, T. K. Ray.

Supervision: Montgomery, Clarke, Kompaniyets, T. K. Ray, Mosites.

Conflict of Interest Disclosures: None reported.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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