Morbidity and mortality in a prospective cohort of people who were homeless during the COVID-19 pandemic

Frontiers in Public Health

Public Health

Aurélie Tinland¹  Ikrame Hafrad²  Sandrine Loubiere³  Pascal Auquier³  Elisabetta Monfardini⁴  Emilie Mosnier⁵  Thomas Bosetti⁶  Marine Mosnier⁶ 

[1] CEReSS – Health Service Research and Quality of Life Center, EA 3279: CEReSS – Health Service Research and Quality of Life Center, School of medicine – La Timone Medical Campus, Aix-Marseille University, Marseille, France;Department of Psychiatry, Assistance Publique – Hôpitaux de Marseille, Marseille, France;Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique – Hôpitaux de Marseille, Marseille, France;Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique – Hôpitaux de Marseille, Marseille, France;CEReSS – Health Service Research and Quality of Life Center, EA 3279: CEReSS – Health Service Research and Quality of Life Center, School of medicine – La Timone Medical Campus, Aix-Marseille University, Marseille, France;Department of Psychiatry, Assistance Publique – Hôpitaux de Marseille, Marseille, France;INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Aix Marseille University, Marseille, France;Médecins du Monde – Doctors of the World, Marseille, France;

关键词: COVID-19;    seroprevalence;    morbidity;    mortality;    hospitalization;    homelessness;   

DOI  :  10.3389/fpubh.2023.1233020

 received in 2023-06-01, accepted in 2023-08-30,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionCertain living conditions, such as homelessness, increase health risks in epidemic situations. We conducted a prospective observational cohort study to investigate the impact of the COVID-19 pandemic on morbidity and mortality in adult people who were homeless.MethodsThe study population comprised around 40% of the entire population experiencing homelessness in Marseille. They were enrolled at 48 different locations during the first pandemic wave (June to August 2020) and were followed up 3 and 6 months later. Rapid serological screening for SARS-CoV-2 was performed by community outreach teams at each follow-up, who also conducted interviews. Death registers and hospital administrative databases were consulted.ResultsA total of 1,332 participants [mean age 40.1 years [SD 14.2], women 339 (29.9%)] were enrolled in the cohort. Of these, 192 (14.4%) participants were found positive for COVID-19 and were propensity score matched (1:3) and compared with 553 non-COVID-19 cases. Living in emergency shelters was associated with COVID-19 infection. While 56.3% of the COVID-19-infected cohort reported no symptoms, 25.0% were hospitalized due to the severity of the disease. Presence of three or more pre-existing comorbidities was associated with all-cause hospitalization. Among COVID-19 cases, only older age was associated with COVID-19 hospitalization. Three deaths occurred in the cohort, two of which were among the COVID-19 cases.ConclusionThe study provides new evidence that the population experiencing homelessness faces higher risks of infection and hospitalization due to COVID-19 than the general population. Despite the efforts of public authorities, the health inequities experienced by people who are homeless remained major. More intensive and appropriate integrated care and earlier re-housing are needed.

【 授权许可】

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Copyright © 2023 Loubiere, Hafrad, Monfardini, Mosnier, Bosetti, Auquier, Mosnier and Tinland.