Dataset Information

COVID-19 Vaccine Coverage and Sociodemographic, Behavioural and Housing Factors Associated with Vaccination among People Experiencing Homelessness in Toronto, Canada: A Cross-Sectional Study.

ABSTRACT: People experiencing homelessness were prioritized for COVID-19 vaccination in Toronto, Canada, due to the high risk of infection and associated complications relative to the general population. We aimed to ascertain COVID-19 vaccine coverage in this population and explore factors associated with the receipt of at least one dose. We collected survey and blood sample data from individuals ages 16+ recruited by random selection at 62 shelters, hotels and encampment sites between 16 June 2021 and 9 September 2021. We report vaccine coverage by dose number and explored sociodemographic, behavioral, health and housing factors associated with vaccination using multivariable modified Poisson regression. In total, 80.4% (95% CI 77.3-83.1%) received at least one vaccine dose, and 63.6% (CI 60.0-67.0%) received two or more doses. Vaccination was positively associated with age (every 10 years adjusted rate ratio (aRR) 1.05 [95% CI 1.03-1.08]), and receipt of influenza vaccination (aRR 1.19 [95% CI 1.11-1.27]). Factors negatively associated with vaccination included female gender (aRR 0.92 [95% CI 0.85-1.0]), Black racial self-identification (aRR 0.89 [95% CI 0.80-0.99]) and low frequencies of masking in public places (aRR 0.83 [95% CI 0.72-0.95]). COVID-19 vaccine coverage is very high among people experiencing homelessness in Toronto, suggesting advocacy and outreach efforts may have been effective.

SUBMITTER: Richard L

PROVIDER: S-EPMC9412474 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature

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COVID-19 Vaccine Coverage and Sociodemographic, Behavioural and Housing Factors Associated with Vaccination among People Experiencing Homelessness in Toronto, Canada: A Cross-Sectional Study.

Richard Lucie L Liu Michael M Jenkinson Jesse I R JIR Nisenbaum Rosane R Brown Michael M Pedersen Cheryl C Hwang Stephen W SW

Vaccines 20220803 8

People experiencing homelessness were prioritized for COVID-19 vaccination in Toronto, Canada, due to the high risk of infection and associated complications relative to the general population. We aimed to ascertain COVID-19 vaccine coverage in this population and explore factors associated with the receipt of at least one dose. We collected survey and blood sample data from individuals ages 16+ recruited by random selection at 62 shelters, hotels and encampment sites between 16 June 2021 and 9 ...[more]

PMID: 36016133

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Project description:ImportancePeople experiencing homelessness are at high risk of SARS-CoV-2 infection. Incident infection rates have yet to be established in these communities and are needed to inform infection prevention guidance and related interventions.ObjectiveTo quantify the SARS-CoV-2 incident infection rate among people experiencing homelessness in Toronto, Canada, in 2021 and 2022 and to assess factors associated with incident infection.Design, setting, and participantsThis prospective cohort study was conducted among individuals aged 16 years and older who were randomly selected between June and September 2021 from 61 homeless shelters, temporary distancing hotels, and encampments in Toronto, Canada.ExposuresSelf-reported housing characteristics, such as number sharing living space.Main outcomes and measuresPrevalence of prior SARS-CoV-2 infection in summer 2021, defined as self-reported or polymerase chain reaction (PCR)- or serology-confirmed evidence of infection at or before the baseline interview, and SARS-CoV-2 incident infection, defined as self-reported or PCR- or serology-confirmed infection among participants without history of infection at baseline. Factors associated with infection were assessed using modified Poisson regression with generalized estimating equations.ResultsThe 736 participants (415 of whom did not have SARS-CoV-2 infection at baseline and were included in the primary analysis) had a mean (SD) age of 46.1 (14.6) years; 486 (66.0%) self-identified as male. Of these, 224 (30.4% [95% CI, 27.4%-34.0%]) had a history of SARS-CoV-2 infection by summer 2021. Of the remaining 415 participants with follow-up, 124 experienced infection within 6 months, representing an incident infection rate of 29.9% (95% CI, 25.7%-34.4%), or 5.8% (95% CI, 4.8%-6.8%) per person-month. Report after onset of the SARS-CoV-2 Omicron variant was associated with incident infection, with an adjusted rate ratio (aRR) of 6.28 (95% CI, 3.94-9.99). Other factors associated with incident infection included recent immigration to Canada (aRR, 2.74 [95% CI, 1.64-4.58]) and alcohol consumption over the past interval (aRR, 1.67 [95% CI, 1.12-2.48]). Self-reported housing characteristics were not significantly associated with incident infection.Conclusions and relevanceIn this longitudinal study of people experiencing homelessness in Toronto, SARS-CoV-2 incident infection rates were high in 2021 and 2022, particularly once the Omicron variant became dominant in the region. Increased focus on homelessness prevention is needed to more effectively and equitably protect these communities.

Project description:Introduction Initial reports suggest people experiencing homelessness (PEH) are at high risk for SARS-CoV-2 infection and associated morbidity and mortality. However, there have been few longitudinal evaluations of the spread and impact of COVID-19 among PEH. This study will estimate the prevalence and incidence of COVID-19 infections in a cohort of PEH followed prospectively in Toronto, Canada. It will also examine associations between individual-level and shelter-level characteristics with COVID-19 infection, adverse health outcomes related to infection and vaccination. Finally, the data will be used to develop and parameterise a mathematical model to characterise SARS-CoV-2 transmission dynamics, and the transmission impact of interventions serving PEH. Design, methods and analysis Ku-gaa-gii pimitizi-win will follow a random sample of PEH from across Toronto (Canada) for 12 months. 736 participants were enrolled between June and September 2021, and will be followed up at 3-month intervals. At each interval, specimens (saliva, capillary blood) will be collected to determine active SARS-CoV-2 infection and serologic evidence of past infection and/or vaccination, and a detailed survey will gather self-reported information, including a detailed housing history. To examine the association between individual-level and shelter-level characteristics on COVID-19-related infection, adverse outcomes, and vaccination, shelter and healthcare administrative data will be linked to participant study data. Healthcare administrative data will also be used to examine long-term (up to 5 years) COVID-19-related outcomes among participants. Ethics and dissemination Ethical approval was obtained from the Unity Health Toronto and University of Toronto Health Sciences Research Ethics Boards (# 20-272). Ku-gaa-gii pimitizi-win was designed in collaboration with community and service provider partners and people having lived experience of homelessness. Findings will be reported to groups supporting Ku-gaa-gii pimitizi-win, Indigenous and other community partners and service providers, funding bodies, public health agencies and all levels of government to inform policy and public health programs.

Project description:BackgroundEvidence is limited about healthcare cost disparities associated with homelessness, particularly in recent years after major policy and resource changes affecting people experiencing homelessness occurred after the onset of the COVID-19 pandemic. We estimated 1-year healthcare expenditures, overall and by type of service, among a representative sample of people experiencing homelessness in Toronto, Canada, in 2021 and 2022, and compared these to costs among matched housed and low-income housed individuals.MethodsData from individuals experiencing homelessness participating in the Ku-gaa-gii pimitizi-win cohort study were linked with Ontario health administrative databases. Participants (n = 640) were matched 1:5 by age, sex-assigned-at-birth and index month to presumed housed individuals (n = 3,200) and to low-income presumed housed individuals (n = 3,200). Groups were followed over 1 year to ascertain healthcare expenditures, overall and by healthcare type. Generalized linear models were used to assess unadjusted and adjusted mean cost ratios between groups.ResultsAverage 1-year costs were $12,209 (95% CI $9,762-$14,656) among participants experiencing homelessness compared to $1,769 ($1,453-$2,085) and $1,912 ($1,510-$2,314) among housed and low-income housed individuals. Participants experiencing homelessness had nearly seven times (6.90 [95% confidence interval [CI] 5.98-7.97]) the unadjusted mean ratio (MR) of costs as compared to housed persons. After adjustment for number of comorbidities and history of healthcare for mental health and substance use disorders, participants experiencing homelessness had nearly six times (adjusted MR 5.79 [95% CI 4.13-8.12]) the expected healthcare costs of housed individuals. The two housed groups had similar costs.ConclusionsHomelessness is associated with substantial excess healthcare costs. Programs to quickly resolve and prevent cases of homelessness are likely to better meet the health and healthcare needs of this population while being a more efficient use of public resources.

Project description:People experiencing homelessness are at elevated risk of SARS-CoV-2 infection, yet estimates generally exclude re-infections and rely on data sources affected by testing policies or study timing. In this prospective cohort study, we report incidence of SARS-CoV-2 infection and re-infections over time using a combination of community-based and study-administered testing, and assessed individual and housing-related factors associated with new infection. Individuals experiencing homelessness were randomly selected from 62 sites across Toronto, Canada, between June and September 2021. Participants provided detailed surveys and biological samples to test for SARS-CoV-2 (by RT-PCR and ELISA) every three months for one year. Self-reported data were verified and augmented through linkage to health administrative databases. Among 640 participants who completed 2,401 interviews, we identified 613 SARS-CoV-2 infection events, representing an incidence rate of 35.3 infections/100-person years (95% CI 31.6-39.4) prior to the onset of Omicron and 97.2 infections/100 person-years (95% CI 86.8-108.8) after Omicron. Nearly 30% (n = 182) of these events were re-infections. In multivariable models, post-Omicron interviews (adjusted rate ratio [aRR] 3.54 [95% CI 3.12-4.02]), history of prior COVID-19 infection (1 infection aRR 2.55 [95% CI 2.29-2.83]; 2 + infections aRR 2.28 [95% CI 1.80-2.89]) and residing in high- or moderate-exposure risk (congregate and shared) housing settings (high-exposure aRR 1.74 [95% CI 1.43-2.11]; moderate-exposure aRR 1.39 [1.15-1.68]) were most significantly associated with new infection. Our findings highlight that existing reports significantly underestimate SARS-CoV-2 infection burden among people experiencing homelessness, but confirms previously reported factors associated with infection, including congregate and shared housing settings. Reducing reliance on overcrowded emergency housing is necessary to reduce infection incidence in this population as well as associated inequities in downstream acute and chronic complications.

Project description:IntroductionPeople experiencing homelessness (PEH) have diverse and complex health and social needs and experience significant barriers to accessing support. As a result, PEH often use the emergency department (ED) for their unmet health and social needs. To address these challenges, the ED Outreach Programme at St. Michael's Hospital was developed with community partners within the Downtown East Toronto Ontario Health Team in Toronto, Canada. PEH presenting in the ED are connected to an outreach worker to identify immediate needs for a safe discharge and to access health and social supports in the community. Following discharge, the outreach worker continues to maintain contact with clients to ensure continuity of care and assists with the coordination, navigation and follow-up of healthcare and community services.MethodsA three-phase community-based participatory research (CBPR) study will be conducted to evaluate patient experience in the ED Outreach Programme. Phase 1 involves conducting interviews with clients and staff/providers to understand their experiences with the programme and identify patient experience domains, constructs and measures. In Phase 2, programme clients, staff/providers and partners with lived experience co-design a set of patient-reported experience measures (PREMs) through focus groups. In Phase 3, the PREMs are pilot-tested to ensure their applicability and utility in the clinical setting. Central to CBPR principles, shared leadership and ownership of the project are facilitated by engaging and empowering community members. This study will contribute to new knowledge of building partnerships with PEH and marginalised communities in healthcare research, evaluation and quality improvement, particularly in developing PREMs.Ethics and disseminationThis study has been approved by the Unity Health Toronto Research Ethics Board (REB#21-315). Findings will be disseminated in peer-reviewed journals, conferences and forums, as well as through collaborating with partners with lived experience, community agencies and government bodies.

Dataset Information

COVID-19 Vaccine Coverage and Sociodemographic, Behavioural and Housing Factors Associated with Vaccination among People Experiencing Homelessness in Toronto, Canada: A Cross-Sectional Study.

Publications

COVID-19 Vaccine Coverage and Sociodemographic, Behavioural and Housing Factors Associated with Vaccination among People Experiencing Homelessness in Toronto, Canada: A Cross-Sectional Study.

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