Article Figures & Tables
Figures
- Figure 1:
Diagram illustrating how the study cohort was built. Note: ALC = alternate level of care (a clinical designation identifying patients in Ontario hospitals who no longer require the intensity of resources provided in their current acute care setting and are waiting for discharge to an appropriate destination), DOLC = date of last contact, OHIP = Ontario Health Insurance Plan.
Tables
Characteristic at index No. (%) of patients* p value Standardized difference, % People with a recent history of homelessness
n = 29 407Community-dwelling population
n = 14 494 301Sociodemographic characteristics Age, yr, median (IQR) 38 (28–52) 41 (23–59) < 0.001 5 Age group, yr < 0.001 Youth (< 25) 4789 (16.3) 3 996 738 (27.6) 28 Young adults (25–39) 10 526 (35.8) 2 853 540 (19.7) 37 Older adults (40–64) 11 898 (40.5) 4 949 782 (34.1) 13 Seniors (≥ 65) 2194 (7.5) 2 694 241 (18.6) 34 Male 19 994 (68.0) 7 125 208 (49.2) < 0.001 39 Immigrated within past 10 yr† 510 (1.7) 624 664 (4.3) < 0.001 15 Immigrated as refugee† 217 (0.7) 106 997 (0.7) 0.99 0 Income quintile‡ < 0.001 1 (lowest) 12 723 (43.3) 2 724 338 (18.8) 55 2 6402 (21.8) 2 791 099 (19.3) 6 3 5166 (17.6) 3 354 429 (19.3) 14 4 2744 (9.3) 2 873 618 (19.8) 30 5 (highest) 2372 (8.1) 2 750 817 (19.0) 32 Level of urbanicity < 0.001 Large CMA (> 500 000 population) 17 018 (57.9) 8 802 812 (60.7) 6 Small to medium-sized urban centres (10 000–500 000 population 10 082 (34.3) 3 959 178 (27.3) 15 Areas with < 10 000 population 1660 (5.6) 1 280 134 (8.8) 12 Unknown or missing 647 (2.2) 452 177 (3.1) 6 Comorbidities and prior health care use Asthma or COPD 7308 (24.9) 2 344 954 (16.2) < 0.001 22 Diabetes 3587 (12.2) 1 486 515 (10.3) < 0.001 6 Congestive heart failure 820 (2.8) 264 745 (1.8) < 0.001 6 Hypertension 4833 (16.4) 3 072 844 (21.2) < 0.001 12 Care related to mental health in previous year 21 905 (74.5) 1 909 412 (13.2) < 0.001 157 Psychotic disorders 9539 (32.4) 171 880 (1.2) < 0.001 92 Nonpsychotic disorders 16 683 (56.7) 1 744 055 (12.0) < 0.001 107 Substance use disorders 15 097 (51.3) 204 393 (1.4) < 0.001 137 No. of primary care visits in previous year, median (IQR) 19 (6–47) 5 (1–11) < 0.001 89 Note: Cells representing ≤ 5 individuals are suppressed to protect individual privacy. CMA = census metropolitan area, COPD = chronic obstructive pulmonary disease, IQR = interquartile range.
↵* Unless indicated otherwise.
↵† Immigration status defined based on presence of a landing date in the Immigration, Refugees and Citizenship Canada Permanent Resident Database from 2008 to 2018.
↵‡ Income quintiles at the Dissemination Area level, derived from 2016 census data. Missing and unknown values were recoded to quintile 3.
Outcome No. of patients Rate per 100 person-years Tested for SARS-CoV-2 People with a recent history of homelessness 8451 62.10 Community-dwelling people 1 266 716 17.24 Tested positive for SARS-CoV-2 People with a recent history of homelessness 274 2.01 Community-dwelling people 28 430 0.39 Admitted to hospital with COVID-19 People with a recent history of homelessness 104 0.69 Community-dwelling people 3685 0.05 Admitted to hospital with COVID-19 and required intensive care People with a recent history of homelessness 15 0.10 Community-dwelling people 1053 0.01 Died within 21 d of positive SARS-CoV-2 test People with a recent history of homelessness 10 0.07 Community-dwelling people 730 0.01 Note: COVID-19 = coronavirus disease 2019, SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.
- Table 3:
Adjusted and unadjusted hazard of outcomes related to COVID-19 (Jan. 23 to July 31, 2020) for people with a recent history of homelessness
Characteristic Hazard ratio (95% CI); outcome Tested* Positivity† Hospital admission‡ Intensive care§ Death¶ Unadjusted analysis People with a recent history of homelessness (Ref. = community-dwelling people) Preshutdown period: Jan. 23 to Mar. 13 3.06 (2.33–4.03) NR NR NR NR Peak period: Mar. 14 to June 16 5.06 (4.93–5.19) 5.07 (4.94–5.20) 65.12 (53.45–79.34) 33.75 (20.27–56.18) 7.64 (4.09–14.24) Reopening period: June 17 to July 31 2.39 (2.30–2.49) 1.05 (1.04–1.07) 0.51 (0.17–1.59) NR NR Adjusted analysis People with a recent history of homelessness (Ref. = community-dwelling people) Preshutdown period: Jan. 23 to Mar. 13 1.61 (1.22–2.11) NR NR NR NR Peak period: Mar. 14 to June 16 2.95 (2.88–3.03) 3.66 (3.22–4.16) 20.35 (16.23–25.53) 10.20 (5.81–17.93) 5.73 (3.01–10.91) Reopening period: June 17 to July 31 1.45 (1.39–1.51) 1.76 (1.15–2.71) 0.38 (0.12–1.17) NR NR Age group, yr (Ref. = youth [18–24 yr]) Young adults (25–39) 2.02 (2.01–2.03) 2.05 (1.97–2.13) 3.47 (2.70–4.46) 4.39 (2.37–8.14) 4.99 (0.56–44.53) Older adults (40–64) 2.03 (2.02–2.04) 2.18 (2.10–2.26) 9.84 (7.86–12.31) 21.67 (12.45–37.73) 44.24 (6.16–317.75) Seniors (≥ 65) 1.90 (1.89–1.91) 1.31 (1.25–1.37) 17.66 (14.04–22.2) 28.81 (16.40–50.61) 321.6 (44.9–2299.9) Sex (Ref. = female) 0.76 (0.76–0.76) 0.91 (0.89–0.94) 1.31 (1.23–1.40) 1.88 (1.66–2.14) 1.36 (1.18–1.58) Immigration status** (Ref. = not an immigrant) 0.87 (0.86–0.87) 1.83 (1.75–1.90) 1.41 (1.22–1.63) 1.64 (1.27–2.11) 0.93 (0.57–1.51) Income quintile (Ref. = highest income quintile)††‡‡ 1 (lowest income) 0.96 (0.95–0.96) 2.01 (1.93–2.09) 2.02 (1.82–2.25) 1.93 (1.57–2.36) 1.64 (1.30–2.08) 2 0.95 (0.95–0.96) 1.52 (1.46–1.58) 1.38 (1.23–1.55) 1.48 (1.20–1.83) 1.22 (0.96–1.56) 3 0.94 (0.94–0.95) 1.42 (1.36–1.48) 1.33 (1.18–1.49) 1.27 (1.02–1.58) 1.24 (0.97–1.58) 4 0.94 (0.94–0.95) 1.18 (1.13–1.23) 1.19 (1.06–1.34) 1.34 (1.08–1.67) 1.00 (0.77–1.30) Urbanicity (Ref. = large CMA [> 500 000 population]) Small to medium-sized urban centres (10 000–500 000 population 1.13 (1.13–1.14) 0.48 (0.47–0.50) 0.44 (0.41–0.48) 0.45 (0.39–0.53) 0.51 (0.43–0.61) Areas with < 10 000 population 1.11 (1.10–1.11) 0.30 (0.28–0.32) 0.25 (0.21–0.31) 0.29 (0.21–0.41) 0.27 (0.18–0.40) Unknown 1.11 (1.10–1.13) 0.68 (0.63–0.74) 0.41 (0.32–0.54) 0.50 (0.31–0.81) 0.20 (0.09–0.45) Comorbidities at baseline (Ref. = no comorbidity) Asthma or COPD 1.24 (1.24–1.25) 1.06 (1.03–1.09) 1.27 (1.18–1.37) 1.32 (1.15–1.53) 1.36 (1.17–1.59) Diabetes 1.02 (1.01–1.03) 1.38 (1.34–1.43) 1.78 (1.66–1.92) 2.22 (1.94–2.54) 1.68 (1.44–1.95) Congestive heart failure 1.48 (1.47–1.49) 1.42 (1.32–1.52) 1.92 (1.73–2.13) 1.40 (1.13–1.74) 2.51 (2.09–3.01) Hypertension 1.10 (1.10–1.11) 1.30 (1.26–1.34) 1.63 (1.50–1.76) 1.57 (1.36–1.81) 2.35 (1.91–2.89) No. of outpatient visits in past year 1.01 (1.01–1.01) 1.01 (1.01–1.01) 1.01 (1.01–1.01) 1.01 (1.01–1.01) 1.01 (1.01–1.01) Health care for mental health in past year 1.40 (1.40–1.41) 1.04 (1.01–1.08) 1.22 (1.12–1.32) 0.98 (0.83–1.16) 1.37 (1.14–1.65) Note: CI = confidence interval, CMA = census metropolitan area, COPD = chronic obstructive pulmonary disease, COVID-19 = coronavirus disease 2019, NR = insufficient outcomes in group to report, Ref. = reference category, SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.
↵* Receipt of at least 1 test for SARS-CoV-2 that was not cancelled or rejected.
↵† Receipt of at least 1 positive test for confirmed SARS-CoV-2 infection.
↵‡ At least 1 hospital admission for confirmed COVID-19 or within 21 d of the first positive SARS-CoV-2 test result.
↵§ At least 1 hospital admission requiring intensive care for confirmed COVID-19 or within 21 d of the first positive SARS-CoV-2 test result.
↵¶ Death within 21 d of the first positive SARS-CoV-2 test result.
↵** Immigration status defined on the basis of the presence of a landing date in the Immigration, Refugees and Citizenship Canada Permanent Resident Database between 2008 and 2018.
↵†† Income quintiles at the Dissemination Area level, derived from census 2016 data.
↵‡‡ Missing and unknown values recoded to quintile 3.
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