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COVID-19 Hospitalizations Among Incarcerated or Homeless People

COVID-19-infected people experiencing incarceration or homelessness in the US had higher rates of hospitalization and readmission than the general population.

In the US, people experiencing incarceration (PEI) and people experiencing homelessness (PEH) are more likely to contract COVID-19 due to congregate living and subpar vaccination rates. Many PEI and PEH are at heightened risk for severe COVID-19 disease do to underlying health conditions.

To better understand how COVID-19 affects these vulnerable populations, one study, published today in JAMA Network Open, compared hospitalization rates of PEI and PEH with the US general public.

The cross-sectional analysis utilized data from the Premier Healthcare Database, an all-payer, hospital-based, administrative database of hospital discharge records. The investigators included adults 18 and older who were evaluated in an emergency department or hospitalized and discharged from the study period April 1, 2020-June 30, 2021. The general population control group included all adults who contracted COVID-19 and were not identified as PEI or PEH.

The study population included a total of 3415 PEI and 9434 PEH who presented with COVID-19 at one of 800 included hospitals across the US. The investigators calculated hospitalization proportions and outcomes, including intensive care unit admission, invasive mechanical ventilation (IMV), mortality, length of stay, and readmission. They used multivariable regression to adjust for potential cofounders.

The results showed that PEI (63.5%) and PEH (64.5%) were hospitalized more frequently than the general population (49.7%). PEI and PEH hospitalizations were more common in younger, non-Hispanic Black men than in other population demographics.

While PEI had a higher frequency of IMV (18.9%) and mortality (14.2%), PEH had lower frequencies of IMV (10.0%) and mortality (5.4%) than the general public. Both PEI and PEH had longer average lengths of stay and higher rates of readmission than the control group.

The investigators concluded that the higher rates of hospitalizations among PEI and PEH indicate greater attention is needed to preventative measures and extraneous interventions in these populations. They recommended expanding medical respite to reduce hospitalizations in PEI and PEH.