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Public Health

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

JAMA Network Open

Published Online: August 18, 2022

Original Investigation

Article Information and Disclosures

Ashley A. Meehan, MPH¹;

Isabel Thomas, MPH^1,2;

Libby Horter, MPH^1,3;

Megan Schoonveld, MPH^1,2;

Andrea E. Carmichael, MPH^1,2;

Mitra Kashani, MSc^1,2;

Diana Valencia, MS¹;

Emily Mosites, PhD¹

Author Affiliations

¹Centers for Disease Control and Prevention, COVID-19 Emergency Response, Atlanta, Georgia
²Oak Ridge Institute for Science and Education Fellowship, Oak Ridge Associated Universities, Oak Ridge, Tennessee
³Goldbelt C6, LLC, Chesapeake, Virginia

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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.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.