Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan 4;5(1):e2143407.
doi: 10.1001/jamanetworkopen.2021.43407.

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

Martha P Montgomery  1 , Kai Hong  1 , Kristie E N Clarke  1 , Samantha Williams  1 , Rena Fukunaga  1 , Victoria L Fields  1 , Joohyun Park  1 , Lyna Z Schieber  1 , Lyudmyla Kompaniyets  1 , Colleen M Ray  1 , Lauren A Lambert  1 , Ashley S D'Inverno  1 , Tapas K Ray  1 , Alexiss Jeffers  1 , Emily Mosites  1
Affiliations

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

Martha P Montgomery et al. JAMA Netw Open. .

Abstract

Importance: 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.

Objective: To compare COVID-19 hospitalizations for PEI and PEH with hospitalizations among the general population.

Design, setting, and participants: 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.

Exposures: Incarceration or homelessness.

Main outcomes and measures: 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.

Results: 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%]).

Conclusions and relevance: 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.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

References

    1. Imbert E, Kinley PM, Scarborough A, et al. . Coronavirus disease 2019 outbreak in a San Francisco homeless shelter. Clin Infect Dis. 2020. doi:10.1093/cid/ciaa1071 - DOI - PMC - PubMed
    1. Wallace M, James AE, Silver R, et al. . Rapid transmission of severe acute respiratory syndrome coronavirus 2 in detention facility, Louisiana, USA, May-June, 2020. Emerg Infect Dis. 2021;27(2):421-429. doi:10.3201/eid2702.204158 - DOI - PMC - PubMed
    1. Fazel S, Geddes JR, Kushel M. The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. Lancet. 2014;384(9953):1529-1540. doi:10.1016/S0140-6736(14)61132-6 - DOI - PMC - PubMed
    1. Maruschak LM, Berzofsky M, Unangst J. Medical problems of state and federal prisoners and jail inmates, 2011-12 (NCJ 248491). U.S. Dept of Justice, Office of Justice Programs. February 2015. Accessed February 14, 2021. https://www.bjs.gov/content/pub/pdf/mpsfpji1112.pdf
    1. Maruschak LM, Minton TD. Correctional populations in the United States, 2017-2018 (NCJ 252157). U.S. Dept of Justice, Office of Justice Programs. August 2020. Accessed February 14, 2021. https://www.bjs.gov/content/pub/pdf/cpus1718.pdf