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Incidence of COVID-19 Among Persons Experiencing Homelessness in the US From January 2020 to November 2021

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  How many cases of COVID-19 in the US have occurred among people experiencing homelessness?

Findings  In this cross-sectional study of 64 US jurisdictional health departments, 26 349 cases of COVID-19 among people experiencing homelessness were reported at the state level and 20 487 at the local level. The annual incidence rate of COVID-19 was lower among people experiencing homelessness than in the general population at state and local levels.

Meaning  The findings suggest that incorporating housing and homelessness status in infectious disease surveillance may improve understanding of the burden of infectious diseases among disproportionately affected groups and aid public health decision-making.

Abstract

Importance  A lack of timely and high-quality data is an ongoing challenge for public health responses to COVID-19 among people experiencing homelessness (PEH). Little is known about the total number of cases of COVID-19 among PEH.

Objective  To estimate the number of COVID-19 cases among PEH and compare the incidence rate among PEH with that in the general population.

Design, Setting, and Participants  This cross-sectional study used data from a survey distributed by the Centers for Disease Control and Prevention to all US state, district, and territorial health departments that requested aggregated COVID-19 data among PEH from January 1, 2020, to September 30, 2021. Jurisdictions were encouraged to share the survey with local health departments.

Main Outcomes and Measures  The primary study outcome was the number of cases of COVID-19 identified among PEH. COVID-19 cases and incidence rates among PEH were compared with those in the general population in the same geographic areas.

Results  Participants included a population-based sample of all 64 US jurisdictional health departments. Overall, 25 states, districts, and territories completed the survey, among which 18 states (72.0%) and 27 localities reported COVID-19 data among PEH. A total of 26 349 cases of COVID-19 among PEH were reported at the state level and 20 487 at the local level. The annual incidence rate of COVID-19 among PEH at the state level was 567.9 per 10 000 person-years (95% CI, 560.5-575.4 per 10 000 person-years) compared with 715.0 per 10 000 person-years (95% CI, 714.5-715.5 per 10 000 person-years) in the general population. At the local level, the incidence rate of COVID-19 among PEH was 799.2 per 10 000 person-years (95% CI, 765.5-834.0 per 10 000 person-years) vs 812.5 per 10 000 person-years (95% CI, 810.7-814.3 per 10 000 person-years) in the general population.

Conclusions and Relevance  These results provide an estimate of COVID-19 incidence rates among PEH in multiple US jurisdictions; however, a national estimate and the extent of under- or overestimation remain unknown. The findings suggest that opportunities exist for incorporating housing and homelessness status in infectious disease reporting to inform public health decision-making.

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Article Information

Accepted for Publication: June 29, 2022.

Published: August 18, 2022. doi:10.1001/jamanetworkopen.2022.27248

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

Corresponding Author: Ashley A. Meehan, MPH, Centers for Disease Control and Prevention, COVID-19 Emergency Response,1600 Clifton Rd, Mailstop H24-12, Atlanta, GA 30333 (ameehan@cdc.gov).

Author Contributions: Ms Meehan 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: Meehan, Thomas, Valencia, Mosites.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Meehan, Thomas, Schoonveld, Carmichael, Kashani.

Critical revision of the manuscript for important intellectual content: Meehan, Thomas, Horter, Carmichael, Valencia, Mosites.

Statistical analysis: Meehan, Horter, Schoonveld.

Administrative, technical, or material support: Meehan, Thomas, Valencia.

Supervision: Meehan, Valencia, Mosites.

Conflict of Interest Disclosures: None reported.

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

Additional Contributions: The Health Department liaisons in the Centers for Disease Control and Prevention’s COVID-19 Emergency Response distributed the survey and directed questions from health departments as part of their work duties. They did not receive additional compensation. We thank all participating health departments for gathering these data and submitting them for analysis.

References
1.
US Department of Housing and Urban Development. 2020 AHAR: Part 1—PIT estimates of homelessness in the US. Published March 2021. Accessed October 18, 2021. https://www.huduser.gov/portal/datasets/ahar/2020-ahar-part-1-pit-estimates-of-homelessness-in-the-us.html
2.
Baggett  TP , Liauw  SS , Hwang  SW .  Cardiovascular disease and homelessness.   J Am Coll Cardiol. 2018;71(22):2585-2597. doi:10.1016/j.jacc.2018.02.077 PubMedGoogle ScholarCrossref
3.
Bartels  SJ , Baggett  TP , Freudenreich  O , Bird  BL .  COVID-19 emergency reforms in Massachusetts to support behavioral health care and reduce mortality of people with serious mental illness.   Psychiatr Serv. 2020;71(10):1078-1081. doi:10.1176/appi.ps.202000244 PubMedGoogle ScholarCrossref
4.
Kuhn  R , Richards  J , Roth  S , Clair  K . Homelessness and public health in Los Angeles. March 31, 2020. Accessed October 28, 2021. https://escholarship.org/uc/item/2gn3x56s
5.
Snyder  LD , Eisner  MD .  Obstructive lung disease among the urban homeless.   Chest. 2004;125(5):1719-1725. doi:10.1378/chest.125.5.1719 PubMedGoogle ScholarCrossref
6.
Ghinai  I , Davis  ES , Mayer  S ,  et al.  Risk factors for severe acute respiratory syndrome coronavirus 2 infection in homeless shelters in Chicago, Illinois—March-May, 2020.   Open Forum Infect Dis. 2020;7(11):ofaa477. doi:10.1093/ofid/ofaa477 PubMedGoogle ScholarCrossref
7.
Rogers  JH , Link  AC , McCulloch  D ,  et al; Seattle Flu Study Investigators.  Characteristics of COVID-19 in homeless shelters: a community-based surveillance study.   Ann Intern Med. 2021;174(1):42-49. doi:10.7326/M20-3799 PubMedGoogle ScholarCrossref
8.
Sanche  S , Lin  YT , Xu  C , Romero-Severson  E , Hengartner  N , Ke  R .  High contagiousness and rapid spread of severe acute respiratory syndrome coronavirus 2.   Emerg Infect Dis. 2020;26(7):1470-1477. doi:10.3201/eid2607.200282 PubMedGoogle ScholarCrossref
9.
Baggett  TP , Keyes  H , Sporn  N , Gaeta  JM .  Prevalence of SARS-CoV-2 infection in residents of a large homeless shelter in Boston.   JAMA. 2020;323(21):2191-2192. doi:10.1001/jama.2020.6887 PubMedGoogle ScholarCrossref
10.
Imbert  E , Kinley  PM , Scarborough  A ,  et al.  Coronavirus disease 2019 outbreak in a San Francisco homeless shelter.   Clin Infect Dis. 2021;73(2):324-327. doi:10.1093/cid/ciaa1071 PubMedGoogle ScholarCrossref
11.
Mohsenpour  A , Bozorgmehr  K , Rohleder  S , Stratil  J , Costa  D .  SARS-Cov-2 prevalence, transmission, health-related outcomes and control strategies in homeless shelters: systematic review and meta-analysis.   EClinicalMedicine. 2021;38:101032. doi:10.1016/j.eclinm.2021.101032 PubMedGoogle ScholarCrossref
12.
Mosites  E , Parker  EM , Clarke  KEN ,  et al; COVID-19 Homelessness Team.  Assessment of SARS-CoV-2 infection prevalence in homeless shelters—four US cities, March 27–April 15, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(17):521-522. doi:10.15585/mmwr.mm6917e1 PubMedGoogle ScholarCrossref
13.
Tobolowsky  FA , Gonzales  E , Self  JL ,  et al.  COVID-19 outbreak among three affiliated homeless service sites—King County, Washington, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(17):523-526. doi:10.15585/mmwr.mm6917e2 PubMedGoogle ScholarCrossref
14.
Mosites  E , Harrison  B , Montgomery  MP ,  et al. Public health lessons learned in responding to COVID-19 among people experiencing homelessness in the United States. Public Health Rep. Published online April 29, 2022. doi:10.1177/00333549221083643
15.
USAFacts. US COVID-19 cases and deaths by state. Accessed October 28, 2021. https://usafacts.org/visualizations/coronavirus-covid-19-spread-map
16.
US Census Bureau. County population totals: 2010-2019. Accessed October 18, 2021. https://www.census.gov/data/datasets/time-series/demo/popest/2010s-counties-total.html
18.
Dean  AG , Sullivan  KM , Soe  MM . OpenEpi: open source epidemiologic statistics for public health. Updated April 6, 2013. Accessed June 28, 2022. http://www.OpenEpi.com
19.
Moore  G , Gerdtz  M , Manias  E , Hepworth  G , Dent  A .  Socio-demographic and clinical characteristics of re-presentation to an Australian inner-city emergency department: implications for service delivery.   BMC Public Health. 2007;7:320. doi:10.1186/1471-2458-7-320 PubMedGoogle ScholarCrossref
20.
Lash  RR , Moonan  PK , Byers  BL ,  et al; COVID-19 Contact Tracing Assessment Team.  COVID-19 case investigation and contact tracing in the US, 2020.   JAMA Netw Open. 2021;4(6):e2115850. doi:10.1001/jamanetworkopen.2021.15850 PubMedGoogle ScholarCrossref
21.
Yoon  JC , Montgomery  MP , Buff  AM ,  et al.  Coronavirus disease 2019 (COVID-19) prevalences among people experiencing homelessness and homelessness service staff during early community transmission in Atlanta, Georgia, April-May 2020.   Clin Infect Dis. 2021;73(9):e2978-e2984. doi:10.1093/cid/ciaa1340 PubMedGoogle ScholarCrossref
22.
Hsu  HE , Ashe  EM , Silverstein  M ,  et al.  Race/ethnicity, underlying medical conditions, homelessness, and hospitalization status of adult patients with COVID-19 at an urban safety-net medical center—Boston, Massachusetts, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(27):864-869. doi:10.15585/mmwr.mm6927a3PubMedGoogle ScholarCrossref
23.
Rossen  LM , Branum  AM , Ahmad  FB , Sutton  P , Anderson  RN .  Excess deaths associated with COVID-19, by age and race and ethnicity—United States, January 26-October 3, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(42):1522-1527. doi:10.15585/mmwr.mm6942e2PubMedGoogle ScholarCrossref
24.
US Department of Housing and Urban Development Exchange. Homeless management information system. Accessed October 18, 2021. https://www.hudexchange.info/programs/hmis/
25.
von Elm  E , Altman  DG , Egger  M , Pocock  SJ , Gøtzsche  PC , Vandenbroucke  JP ; STROBE Initiative.  The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.   J Clin Epidemiol. 2008;61(4):344-349. doi:10.1016/j.jclinepi.2007.11.008 PubMedGoogle ScholarCrossref
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