Hospitalizations during the COVID-19 pandemic among recently homeless individuals: a retrospective population-based matched cohort study

Background — Hospitalizations fell precipitously among the general population during the COVID-19 pandemic. It remains unclear whether individuals experiencing homelessness experienced similar reductions.

Objective — To examine how overall and cause-specific hospitalizations changed among individuals with a recent history of homelessness (IRHH) and their housed counterparts during the first wave of the COVID-19 pandemic, using corresponding weeks in 2019 as a historical control.

Design — Population-based cohort study conducted in Ontario, Canada, between September 30, 2018, and September 26, 2020.

Participants — In total, 38,617 IRHH, 15,022,368 housed individuals, and 186,858 low-income housed individuals matched on age, sex, rurality, and comorbidity burden.

Main Measures — Primary outcomes included medical-surgical, non-elective (overall and cause-specific), elective surgical, and psychiatric hospital admissions.

Key Results — Average rates of medical-surgical (rate ratio: 3.8, 95% CI: 3.7–3.8), non-elective (10.3, 95% CI: 10.1–10.4), and psychiatric admissions (128.1, 95% CI: 126.1–130.1) between January and September 2020 were substantially higher among IRHH compared to housed individuals. During the peak period (March 17 to June 16, 2020), rates of medical-surgical (0.47, 95% CI: 0.47–0.47), non-elective (0.80, 95% CI: 0.79–0.80), and psychiatric admissions (0.86, 95% CI: 0.84–0.88) were significantly lower among housed individuals relative to equivalent weeks in 2019. No significant changes were observed among IRHH. During the re-opening period (June 17–September 26, 2020), rates of non-elective hospitalizations for liver disease (1.41, 95% CI: 1.23–1.69), kidney disease (1.29, 95% CI: 1.14–1.47), and trauma (1.19, 95% CI: 1.07–1.32) increased substantially among IRHH but not housed individuals. Distinct hospitalization patterns were observed among IRHH even in comparison with more medically and socially vulnerable matched housed individuals.

Conclusions — Persistence in overall hospital admissions and increases in non-elective hospitalizations for liver disease, kidney disease, and trauma indicate that the COVID-19 pandemic presented unique challenges for recently homeless individuals. Health systems must better address the needs of this population during public health crises.