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
. 2023 Jun 20:11:1090148.
doi: 10.3389/fpubh.2023.1090148. eCollection 2023.

Care-seeking correlates of acute respiratory illness among sheltered adults experiencing homelessness in Seattle, WA, 2019: a community-based cross-sectional study

Julia H Rogers  1   2 , Stephen E Hawes  2 , Caitlin R Wolf  1 , James P Hughes  3   4 , Janet A Englund  5 , Lea M Starita  3   6 , Helen Y Chu  1
Affiliations

Care-seeking correlates of acute respiratory illness among sheltered adults experiencing homelessness in Seattle, WA, 2019: a community-based cross-sectional study

Julia H Rogers et al. Front Public Health. .

Abstract

Objective: Multifarious barriers to accessing healthcare services among people experiencing homelessness (PEH) lead to delays in seeking care for acute infections, including those caused by respiratory viruses. PEH are at high risk of acute respiratory illness (ARI)-related complications, especially in shelter settings that may facilitate virus spread, yet data characterizing healthcare utilization for ARI episodes among sheltered PEH remained limited.

Methods: We conducted a cross-sectional study of viral respiratory infection among adult residents at two homeless shelters in Seattle, Washington between January and May 2019. We assessed factors associated with seeking medical care for ARI via self-report. We collected illness questionnaires and nasal swabs were tested for respiratory viruses by reverse transcription quantitative real-time PCR (RT-qPCR).

Results: We observed 825 encounters from 649 unique participants; 241 (29.2%) encounters reported seeking healthcare for their ARI episode. Seasonal influenza vaccine receipt (adjusted prevalence ratio [aPR] 1.39, 95% CI 1.02-1.88), having health insurance (aPR 2.77, 95% CI 1.27-6.02), chronic lung conditions (aPR 1.55, 95% CI 1.12-2.15), and experiencing influenza-like-illness symptoms (aPR 1.63, 95% CI 1.20 - 2.20) were associated with increased likelihood of seeking care. Smoking (aPR 0.65, 95% CI 0.45-0.92) was associated with decreased likelihood of seeking care.

Discussion: Findings suggest that care seeking for viral respiratory illness among PEH may be supported by prior engagement with primary healthcare services. Strategies to increase healthcare utilization may lead to earlier detection of respiratory viruses.

Keywords: cross-sectional study; health care utilization; homeless shelters; predictors of interest; respiratory virus infection.

PubMed Disclaimer

Conflict of interest statement

HC reported consulting with Ellume, Pfizer, the Bill and Melinda Gates Foundation, Glaxo Smith Kline, and Merck. She has received research funding from Gates Ventures, Sanofi Pasteur, and support and reagents from Ellume and Cepheid outside of the submitted work. JE reported research support from Merck, AstraZenecxa, Pfizer, and GlaxoSmithKline. She was a consultant for Meissa Vaccines, Sanofi Pasteur, and Astra Zeneca. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Stratified analysis of association between virus detected and having sought healthcare with at least one viral respiratory pathogen detected (n = 154). Number of positives per pathogen do not add up to 154 as positive detection was not mutually exclusive. Adjusted prevalence ratios (aPR) are displayed on the logarithmic scale. Human coronavirus (HCoV) sub-types include HCoV-229E, HCoV-OC43, HCoV-NL63, and HCoV-HKU1. “Other” viral pathogens detected include enterovirus, human metapneumovirus, and human parainfluenza viruses. All regression models were adjusted for number of days since symptom onset and having received treatment for an illness episode.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Armstrong GL, Conn LA, Pinner RW. Trends in infectious disease mortality in the United States during the 20th century. J Am Med Assoc. (1999) 281:61–6. doi: 10.1001/jama.281.1.61 - DOI - PubMed
    1. Topoulos S, Giesa C, Gatermann S, Fussen R. Analysis of acute respiratory infections due to influenza virus a, B and RSV during an influenza epidemic 2018. Infection. (2019) 47:425–33. doi: 10.1007/s15010-018-1262-x, PMID: - DOI - PubMed
    1. Bucher SJ, Brickner PW, Vincent RL. Influenzalike illness among homeless persons. Emerg Infect Dis. (2006) 12:1162–3. doi: 10.3201/eid1207.060217, PMID: - DOI - PMC - PubMed
    1. Thiberville SD, Salez N, Benkouiten S, Badiaga S, Charrel R, Brouqui P. Respiratory viruses within homeless shelters in Marseille, France. BMC Res Notes. (2014) 7:1–4. doi: 10.1186/1756-0500-7-81 - DOI - PMC - PubMed
    1. Badiaga S, Richet H, Azas P, Zandotti C, Rey F, Charrel R, et al. . Contribution of a shelter-based survey for screening respiratory diseases in the homeless. Eur J Pub Health. (2009) 19:157–60. doi: 10.1093/eurpub/ckn142, PMID: - DOI - PubMed

Publication types