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

IF 11.3 1区医学 Q1 MEDICINE, GENERAL & INTERNAL Canadian Medical Association journal Pub Date : 2025-03-10 DOI:10.1503/cmaj.241282

Siying S Li, Kimberlyn McGrail, Rhonda J Rosychuk, Michael R Law, Corinne M Hohl

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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.

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与住院患者相比，加拿大无家可归的COVID-19患者到急诊室就诊的结果。

背景：目前尚不清楚加拿大无家可归者（PEH）的COVID-19结局是否与住院患者不同。我们试图确定PEH和有症状的SARS-CoV-2感染的住院患者的住院死亡率、住院率、重症监护率和机械通气率是否存在差异。方法：我们进行了一项倾向评分匹配的队列研究，比较PEH和住院患者因急性症状性COVID-19到急诊室就诊的结果。我们使用了加拿大COVID-19急诊科快速反应网络（CCEDRRN）登记处的数据。我们的倾向评分模型中的协变量包括年龄、性别、合并症、药物使用、疫苗接种状况、既往不复苏记录、医院类型、省份和就诊到急诊科的日历季度、症状持续时间和就诊时疾病的严重程度。结果：我们发现PEH的死亡率（3%）与倾向评分匹配的住院患者队列（3%）没有差异（优势比[OR] 0.87, 95%可信区间[CI] 0.43-1.74）。我们还发现PEH的住院率（44%）与住院患者（45%）没有差异。与隔离的患者相比，PEH的重症监护入院率降低（OR 0.66, 95% CI 0.44-1.00）， PEH与隔离的患者相比，机械通气的使用有减少的趋势，但差异不显著（OR 0.60, 95% CI 0.35-1.02）。解释：我们发现PEH合并COVID-19的死亡率与那些被安置的人没有差异。PEH中重症监护住院率降低的信号可能反映了与我们匹配的临床特征无关的差异治疗。未来关于大流行期间资源分配的研究可以揭示弱势群体面临的潜在不平等，以及如何最好地解决这些问题。

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来源期刊

Canadian Medical Association journal 医学-医学：内科

CiteScore

8.30

自引率

4.10%

发文量

481

审稿时长

4-8 weeks

期刊介绍： CMAJ (Canadian Medical Association Journal) is a peer-reviewed general medical journal renowned for publishing original research, commentaries, analyses, reviews, clinical practice updates, and editorials. Led by Editor-in-Chief Dr. Kirsten Patrick, it has a significant impact on healthcare in Canada and globally, with a 2022 impact factor of 17.4. Its mission is to promote knowledge vital for the health of Canadians and the global community, guided by values of service, evidence, and integrity. The journal's vision emphasizes the importance of the best evidence, practice, and health outcomes. CMAJ covers a broad range of topics, focusing on contributing to the evidence base, influencing clinical practice, and raising awareness of pressing health issues among policymakers and the public. Since 2020, with the appointment of a Lead of Patient Involvement, CMAJ is committed to integrating patients into its governance and operations, encouraging their content submissions.