Outcomes for people experiencing homelessness with COVID-19 presenting to emergency departments in Canada, compared with housed patients.

Abstract

Background: Whether people experiencing homelessness (PEH) have different COVID-19 outcomes than housed patients in Canada remains unclear. We sought to ascertain whether rates of in-hospital mortality, hospital admission, critical care admission, and mechanical ventilation differed between PEH and housed people with symptomatic SARS-CoV-2 infection.

Methods: We conducted a propensity score-matched cohort study to compare the outcomes of PEH and housed patients presenting to emergency departments for acute symptomatic COVID-19. We used data from the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) registry. Covariates in our propensity score model included age, sex, comorbidities, substance use, vaccination status, previous do-not-resuscitate documentation, hospital type, province and calendar quarter of presentation to the emergency department, symptom duration, and severity of illness on presentation.

Results: We found no difference in mortality for PEH (3%) compared with a propensity score-matched cohort of housed patients (3%) (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.43-1.74). We also found no difference in admission rates for PEH (44%) versus housed patients (45%). There was a reduced rate of critical care admission for PEH compared with housed patients (OR 0.66, 95% CI 0.44-1.00), and a trend toward decreased use of mechanical ventilation for PEH versus housed patients, which was not significant (OR 0.60, 95% CI 0.35-1.02).

Interpretation: We found no difference in mortality for PEH with COVID-19 compared with those who were housed. A signal for reduced critical care admission among PEH may reflect differential treatment unrelated to clinical characteristics that we matched for. Future research on resource allocation during pandemics could shed light on potential inequities for vulnerable populations and how best to address them.