People experiencing homelessness in Los Angeles who contract COVID are 2.35 times more likely to die than someone in the general population, according to new study by UCLA, USC, and Los Angeles County.
The study, published in JAMA Network Open this month, suggests that homelessness is a unique risk factor for COVID-related deaths and that the likely cause is the vulnerability brought on by accelerated aging among the homeless, the researchers said.
“Excess risk of mortality for people experiencing homelessness, versus the general population, was observed across all age groups, among male individuals and female individuals, and among Black, Hispanic, and white subpopulations,” said Dr. Randall Kuhn, professor of community health sciences at the UCLA Fielding School of Public Health and a co-author of the research study.
When the pandemic hit, concerns about L.A.’s unsheltered homeless population — the largest in the country — led to a successful call for federal funding to place people in protective housing programs, reduce shelter density, conduct contact tracing for COVID and prioritize vaccinations for homeless people. The hope was that the pandemic would have no worse impact among the homeless than among the general population.
That was not to be. Surveillance teams from the LA County Department of Public Health tallied 256 COVID-related deaths among an estimated 52,000 people experiencing homelessness, or PEH, between January 1, 2020, and November 1, 2021.
“This work shows that COVID-19, like many infectious diseases, is what we call a ‘housing-sensitive condition’,” said co-author Benjamin Henwood, a professor at the USC Suzanne Dworak-Peck School of Social Work. “More aggressive housing and homelessness prevention interventions are needed to mitigate these conditions.”
The study is the latest collaboration between Kuhn, Henwood and colleagues that measures and addresses the extreme health risks faced by people experiencing homelessness, and addressing gaps in research on unsheltered homelessness.
• Kuhn and Henwood led a novel, ongoing survey of L.A.’s unhoused population, sending questions monthly to mobile phones owned by 500 people experiencing homelessness.
• Their UCLA/USC-based team are currently recruiting an additional 500 respondents and working with the new UCLA Initiative for the Study of Hate to estimate the toll of hatred and bias towards unhoused people.
Researchers have long suspected that homelessness exacerbates health disparities and accelerates the normal aging of the body, reducing life expectancy by up to two decades.
“COVID-19 is a disease that feeds on older populations, but age is just a number,” Kuhn said. “We have long thought that prolonged experience of homelessness accelerates the normal aging of the body by perhaps 10 to 15 years. Unhoused people who are age 50-54 had about the same mortality risks as 65-69 year olds in the general population. This is deeply troubling, especially in light of a possible new wave of COVID-19 cases.”
Researchers used data from clinician reports, death certificates, medical examiner reports and vital records. Confirmed COVID deaths included those with a positive COVID test and either COVID listed as a cause of death on a death certificate or the date of death occurring within 60 days of the first confirmed test (and up to 90 days if the patient was intubated). Sudden or unexpected deaths due to violence, drug overdose, etc., were excluded.
There were 50 deaths among women and 205 among men and one person did not fit either category; most occurred during the Delta variant surge of December 2020 to February 2021. Among those who died: 62 Black, 122 Hispanic and 55 white individuals.
“While homelessness dramatically increases the risks for each group, we can’t ignore how high the risks already were for housed Black and Hispanic populations,” said Natalie Porter, a recent UCLA MPH graduate who led the study.
The researchers noted that how people entered into homelessness may have shaped COVID outcomes. Homelessness for Black individuals in the U.S. may be influenced primarily by structural factors, whereas homelessness among white individuals is more commonly influenced by individual factors such as psychiatric conditions and substance abuse
In addition to Henwood, Kuhn and Porter, other authors of the study are Hannah Brosnan and Alicia Chang of the Los Angeles Department of Public Health.
This project was supported in part by the California Center for Population Research at UCLA, which receives core support (grant P2C-HD041022) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.