Abstract

IntroductionPrior research into the prevalence of SARS-CoV-2 infection amongst people experiencing homelessness (PEH) largely relates to people in communal forms of temporary accommodation in contexts where this type of accommodation remained a major part of the response to homelessness during the COVID-19 pandemic. Little is known about the prevalence of SARS-CoV-2 amongst PEH more broadly, and in a policy and practice context that favoured self-contained accommodation, such as Wales, UK.ObjectiveDescribe the prevalence of SARS-CoV-2 amongst PEH in Wales, UK, using routinely collected administrative data from the Secure Anonymised Information Linkage Databank.MethodsRoutinely collected data were used to identify PEH in Wales between 1st March 2020 and 1st March 2021. Using SARS-CoV-2 pathology testing data, prevalence rates were generated for PEH and three comparator groups: (1) the not-homeless population; (2) a cohort ‘exact matched’ for age, sex, local authority and area deprivation; and (3) a matched comparison group created using these same variables and Propensity Score Matching (PSM). Three logistic regressions were run on samples containing each of the comparator groups to explore the effect of experiencing homelessness on testing positive for SARS-CoV-2.ResultsThe prevalence of SARS-CoV-2 infection amongst PEH was 5.0%, compared to the not-homeless population at 5.6%. For the exact matched and PSM match comparator groups, prevalence was 6.9% and 6.7%, respectively. Logistic regression found that SARS-CoV-2 infection was 0.9 times less likely amongst PEH compared to people not experiencing homelessness from the general population. The odds of SARS-CoV-2 infection for PEH was 0.75 and 0.73 where the ‘not-homeless’ comparators were from the exact match and PSM samples, respectively.ConclusionOur analysis revealed that a year into the COVID-19 pandemic, the prevalence of SARS-CoV-2 amongst PEH in Wales was lower than the general population. A policy response to homelessness that moved away from communal accommodation may be partly responsible for the reduced SAR-CoV-2 infection amongst PEH.

Highlights

  • Prior research into the prevalence of SARS-CoV-2 infection amongst people experiencing homelessness (PEH) largely relates to people in communal forms of temporary accommodation in contexts where this type of accommodation remained a major part of the response to homelessness during the COVID-19 pandemic

  • We aim to describe the prevalence of SARS-CoV-2 amongst PEH in Wales and consider the extent to which the response to homelessness may have led to the prevalence rates identified

  • All data sets were linked using a unique identifier for each person in Wales, the Anonymised Linkage Field (ALF), which is assigned to all data within Secure Anonymised Information Linkage (SAIL) [17]

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Summary

Introduction

Prior research into the prevalence of SARS-CoV-2 infection amongst people experiencing homelessness (PEH) largely relates to people in communal forms of temporary accommodation in contexts where this type of accommodation remained a major part of the response to homelessness during the COVID-19 pandemic. Concerns centred upon people who were literally roofless and those in communal forms of accommodation, such as shelters and hostels, where facilities and air space were shared. It was feared these environments could hamper a person’s ability to adhere to public health instructions regarding hand hygiene, maintaining physical distancing, and isolation when symptomatic or following a positive SARS-CoV-2 test [1, 2]. Mainly from outside the US, have sought to compare SAR-CoV-2 prevalence amongst

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