236 Access to Covid-19 Testing by Homeless/Housing-Insecure Individuals in Northeast Ohio

Abstract

Homelessness and housing insecurity is a global public health issue that leads to increased mortality from a multitude of health conditions and low life expectancy. The complex interplay between medical, psychiatric and social factors raises questions about how this population accesses available health care resources. This is magnified in times of global health crises, such as the current coronavirus disease 2019 (COVID-19) pandemic. Patients experiencing housing insecurity may have limited access to health care resources, and live in settings, such as homeless shelters, that place them at high risk for COVID-19 transmission. Moreover, the high prevalence of underlying medical conditions in this population puts them at high risk for developing severe illness associated with COVID-19. Therefore, how this population accesses COVID-19 testing is of public health interest. This study’s objective was to compare the testing patterns of homeless/housing insecure patients for COVID-19, as well as results, compared to the general population across a large health system. A retrospective cohort study was conducted at the Cleveland Clinic Health System in Ohio and Florida. All patients tested for COVID-19 between March 8 and April 15, 2020 were included, including drive-through, emergency department (ED)-based and inpatient testing. Homeless/housing-insecure patients were identified based on a previously utilized address-based registry: patients listing their address as “homeless” or using the address of transitional housing/homeless shelter during at least one ED visit across the health system between 2014 and 2019. Descriptive statistics were calculated and compared with Chi-squared testing. During the study period, 21,561 patients were tested for COVID-19, 94 of whom were identified as homeless/housing insecure (0.4%). 3/94 of these patients (3.2%) tested positive for COVID-19, compared to 2,027/21,467 patients (9.4%) in the general population. Out of all patients tested, 12,776 patients had a testing site listed, 78 of whom were homeless/housing insecure. Homeless/housing insecure individuals were significantly more likely to be tested for COVID-19 in the ED setting rather than drive-through testing, X2 (1, N = 12718) = 22.8, p < .00001) [Table 1]. In a regional health system during the COVID-19 pandemic, homeless and housing-insecure patients were reliant on the ED to access COVID-19 testing. Despite risk factors in this population for disease transmission, patients had a low likelihood of testing positive, suggesting that the disease is likely underdiagnosed in this population. Expanding testing availability outside of the ED may improve COVID-19 detection and interventions in homeless and housing insecure individuals, and thus inform public health interventions to reduce disease transmission in this high risk population.