RESUMEN
INTRODUCTION: The World Health Organization (WHO) declared severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a pandemic in March 2020. Theoretically, homeless patients could have disproportionately worse outcomes from COVID-19, but little research has corroborated this claim. This study aimed to examine the demographics and incidence of COVID-19 in homeless vs non-homeless emergency department (ED) patients. METHODS: This is a retrospective study of all patients seen in the University of Louisville Hospital Emergency Department (ULH ED) from March 2019 to December 2020, excluding January and February 2020. Data was collected from the Kentucky Homeless Management Information System (HMIS) and ULH electronic health records. RESULTS: A total of 51,532 unique patients had 87,869 visits during the study period. There was a 18.1% decrease in homeless patient visits over the time period, which was similar to the decrease in non-homeless patient visits (19.2%). In the total population, 9471 individuals had known COVID-19 testing results, with a total of 610 positive (6.4% positivity rate). Of the 712 homeless ED patients, 39 tested positive (5.5% positivity rate). After adjusting for age, gender identity, race, and insurance, there was no statistically significant difference in test positivity between homeless and non-homeless patients, OR 1.23 (0.88, 1.73). Homeless patients were less likely to be admitted to either the intensive care unit (ICU) or hospital (OR = 0.55, 95% CI: OR 0.51, 0.60) as they were more likely to be discharged (OR = 1.65, 95% CI: 1.52, 1.79). CONCLUSION: Previous literature has indicated that higher disease burden, lack of access to social distancing, and poor hygiene would increase the risk of homeless individuals contracting COVID-19 and experiencing serious morbidity. However, this study found that homelessness was not an independent risk factor for COVID-19 infection.
Asunto(s)
COVID-19/diagnóstico , Servicio de Urgencia en Hospital/estadística & datos numéricos , Personas con Mala Vivienda/estadística & datos numéricos , Adulto , COVID-19/epidemiología , Prueba de COVID-19/métodos , Prueba de COVID-19/estadística & datos numéricos , Servicio de Urgencia en Hospital/organización & administración , Femenino , Humanos , Incidencia , Kentucky/epidemiología , Masculino , Persona de Mediana Edad , Estudios RetrospectivosAsunto(s)
COVID-19 , Personas con Mala Vivienda , Servicio de Urgencia en Hospital , Humanos , Incidencia , SARS-CoV-2RESUMEN
BACKGROUND: The COVID-19 pandemic has altered behaviors in the general population, as well as processes in the healthcare industry. Patients may be afraid to pursue care in the emergency department (ED) due to perceived risk of infection. The objective of this study was to determine the impact of COVID-19 on ED metrics. METHODS: At one metropolitan trauma center ED, we conducted a review of all visits from February to May in 2020 and compared findings with the same months from 2019. RESULTS: A total of 34,213 ED visits occurred during the study periods (18,471 in 2019 and 15,742 in 2020), with a decline in patient visits occurring after state emergency declarations. In 2020, patients were less likely to be female and more likely to arrive by ambulance. Diagnoses in the musculoskeletal, neurologic, and genitourinary categories occurred in lower proportions in 2020; toxicology, psychiatry, and infectious diseases occurred in higher proportions. In contrast to other insurance categories, Medicare patients comprised a larger share of ED visits in 2020 compared to 2019. DISCUSSION: Despite relatively low local prevalence of COVID-19, we report decreases in ED volume for some medical diagnosis categories. A volume rebound occurred in May 2020, but did not reach 2019 levels. Public health officials should encourage local populations to seek emergency care when concerned, and could consider programs to provide transportation. Patients should continue to protect themselves with social distancing and masks.