Hospitalizations for COVID-19 Among US People Experiencing Incarceration or Homelessness

Martha P Montgomery,Lyudmyla Kompaniyets,Rena Fukunaga,Tapas K Ray,Ashley S D’Inverno,Kai Hong,Alexiss Jeffers,Victoria L Fields,Lyna Z Schieber,Samantha Williams,Kristie E N Clarke,Emily Mosites,Colleen M Ray,Lauren A Lambert,Joohyun Park

doi:10.1001/jamanetworkopen.2021.43407

Martha P Montgomery, Lyudmyla Kompaniyets + Show 13 more

Open Access

https://doi.org/10.1001/jamanetworkopen.2021.43407

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Abstract

People experiencing incarceration (PEI) and people experiencing homelessness (PEH) have an increased risk of COVID-19 exposure from congregate living, but data on their hospitalization course compared with that of the general population are limited. To compare COVID-19 hospitalizations for PEI and PEH with hospitalizations among the general population. This cross-sectional analysis used data from the Premier Healthcare Database on 3415 PEI and 9434 PEH who were evaluated in the emergency department or were hospitalized in more than 800 US hospitals for COVID-19 from April 1, 2020, to June 30, 2021. Incarceration or homelessness. Hospitalization proportions were calculated. and outcomes (intensive care unit admission, invasive mechanical ventilation [IMV], mortality, length of stay, and readmissions) among PEI and PEH were compared with outcomes for all patients with COVID-19 (not PEI or PEH). Multivariable regression was used to adjust for potential confounders. In total, 3415 PEI (2952 men [86.4%]; mean [SD] age, 50.8 [15.7] years) and 9434 PEH (6776 men [71.8%]; mean [SD] age, 50.1 [14.5] years) were evaluated in the emergency department for COVID-19 and were hospitalized more often (2170 of 3415 [63.5%] PEI; 6088 of 9434 [64.5%] PEH) than the general population (624 470 of 1 257 250 [49.7%]) (P < .001). Both PEI and PEH hospitalized for COVID-19 were more likely to be younger, male, and non-Hispanic Black than the general population. Hospitalized PEI had a higher frequency of IMV (410 [18.9%]; adjusted risk ratio [aRR], 1.16; 95% CI, 1.04-1.30) and mortality (308 [14.2%]; aRR, 1.28; 95% CI, 1.11-1.47) than the general population (IMV, 88 897 [14.2%]; mortality, 84 725 [13.6%]). Hospitalized PEH had a lower frequency of IMV (606 [10.0%]; aRR, 0.64; 95% CI, 0.58-0.70) and mortality (330 [5.4%]; aRR, 0.53; 95% CI, 0.47-0.59) than the general population. Both PEI and PEH had longer mean (SD) lengths of stay (PEI, 9 [10] days; PEH, 11 [26] days) and a higher frequency of readmission (PEI, 128 [5.9%]; PEH, 519 [8.5%]) than the general population (mean [SD] length of stay, 8 [10] days; readmission, 28 493 [4.6%]). In this cross-sectional study, a higher frequency of COVID-19 hospitalizations for PEI and PEH underscored the importance of adhering to recommended prevention measures. Expanding medical respite may reduce hospitalizations in these disproportionately affected populations.

Highlights

People experiencing incarceration (PEI) and people experiencing homelessness (PEH) often live in congregate settings where large outbreaks of SARS-CoV-2 can occur rapidly.[1,2] Many PEI and PEH are at increased risk for severe illness from COVID-19 because of underlying medical conditions.[3,4] An estimated 2.1 million people are incarcerated nationally, with approximately two-thirds in state and federal prisons and one-third in local jails and detention centers.[5]
We identified 3415 PEI (2952 men [86.4%]; mean [SD] age, 50.8 [15.7] years), 9434 PEH (6776 men [71.8%]; mean [SD] age, 50.1 [14.5] years), and 1 257 250 patients in the general population with COVID-19 who were evaluated in the emergency department only or hospitalized (Table 2)
Several underlying medical conditions were more common among PEI and PEH with COVID-19 in the emergency department than among the general population, including chronic obstructive pulmonary disease, liver disease, tobacco use, substance use disorder, and serious mental illness

Summary

Introduction

People experiencing incarceration (PEI) and people experiencing homelessness (PEH) often live in congregate settings where large outbreaks of SARS-CoV-2 can occur rapidly.[1,2] Many PEI and PEH are at increased risk for severe illness from COVID-19 because of underlying medical conditions.[3,4] An estimated 2.1 million people are incarcerated nationally, with approximately two-thirds in state and federal prisons (typically people serving sentences of >1 year) and one-third in local jails and detention centers (typically detained for

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