Pandemic Housing Policy: Examining the Relationship Among Eviction, Housing Instability, Health Inequity, and COVID-19 Transmission

Benfer, Emily A.; Vlahov, David; Long, Marissa; Walker-Wells, Evan; Pottenger, J. L.; Gonsalves, Gregg; Keene, Danya E.

doi:10.2139/ssrn.3736457

Cited by 3 publications

(2 citation statements)

References 68 publications

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“…Initial responses to COVID-19 through established channels were thus accompanied by additional efforts to address the evolving disparities. Nevertheless, minoritized and vulnerable communities still had reduced access to testing and treatments and have endured disproportionate impacts of social distancing and lockdown policies on employment, education, and housing [4][5][6][7][8]. Against this backdrop, achieving equitable vaccinations has and continues to be one of the most critical public health challenges for mitigating the impact of the COVID-19 pandemic and achieving long-term control.…”

Section: Introductionmentioning

confidence: 99%

Quantifying Inequities in COVID-19 Vaccine Distribution Over Time by social vulnerability, race and ethnicity, and location: A Population-Level Analysis in St. Louis and Kansas City, Missouri

Mody

Bradley

Redkar

et al. 2022

Preprint

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BACKGROUND: Equity in vaccination coverage is a cornerstone to a successful public health response to COVID-19. To deepen understand of the extent to which vaccination coverage compared to initial strategies for equitable vaccination, we explore primary vaccine series and booster rollout over time and by race/ethnicity, social vulnerability, and geography. METHODS AND FINDINGS: We analyzed data from the Missouri State Department of Health and Senior Services on all COVID-19 vaccinations administered across 7 counties in the St. Louis region and 4 counties in the Kansas City Region. We compared rates of receiving the primary COVID-19 vaccine series and boosters relative to time, race/ethnicity, zip code-level social vulnerability index (SVI), vaccine location type, and COVID-19 disease burden. We adapted a well-established tool for measuring inequity—the Lorenz curve—to quantify inequities in COVID-19 vaccination relative to these key metrics. Between 12/15/2020 and 2/15/2022, 1,762,508 individuals completed the primary series and 871,896 had received a booster. During early phases of the primary series rollout, Black and Hispanic individuals from high SVI zip codes were vaccinated at less than half the rate of White individuals, but rates increased over time until they were higher than rates in White individuals after June 2021; Asian individuals maintained high levels of vaccination throughout. Increasing vaccination rates in Black and Hispanic communities corresponded with periods when more vaccinations were offered at small community-based sites such as pharmacies rather than larger health systems and mass vaccination sites. Using Lorenz curves, zip codes in the quartile with the lowest rates of primary series completion accounted for 19.3%, 18.1%, 10.8%, and 8.8% of vaccinations but represented 25% of either the total population, cases, deaths, or population-level SVI, respectively. When tracking Gini coefficients, these disparities were greatest earlier during rollout, but improvements were slow and modest and vaccine disparities remained across all metrics even after one year. Patterns of disparities for boosters were similar but often of much greater magnitude during rollout in Fall 2021. Study limitations include inherent limitations in vaccine registry dataset such as missing and misclassified race/ethnicity and zip code variables and potential changes in zip code population sizes since census enumeration. CONCLUSIONS: Racial inequity in the initial COVID-19 vaccination and booster rollout in two large U.S. metropolitan areas were apparent across racial/ethnic communities, across levels of social vulnerability, over time, and across types of vaccination administration sites. Disparities in receipt of the primary vaccine series attenuated over time during a period in which sites of vaccination administration diversified, but were recapitulated during booster rollout. These findings highlight how public health strategies from the outset must directly target these deeply embedded structural and systemic determinants of disparities and track equity metrics over time to avoid perpetuating inequities in health care access.

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Section: Introductionmentioning

confidence: 99%

Quantifying Inequities in COVID-19 Vaccine Distribution Over Time by social vulnerability, race and ethnicity, and location: A Population-Level Analysis in St. Louis and Kansas City, Missouri

Mody

Bradley

Redkar

et al. 2022

Preprint

View full text Add to dashboard Cite

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“…These challenges referred mainly to rapid coordination of efforts during outbreakrelated shelter shutdowns, strong partnerships between community care facilities for people experiencing homelessness, local non-governmental organizations with local health department. In addition, the State provided a constant source of guidance to first isolation of infected people and then housing solutions (51)(52)(53). Nevertheless, the most critical point is targeting effective prevention strategies including COVID-19 vaccination efforts among people experiencing homelessness.…”

mentioning

confidence: 99%

Morbidity and mortality in a prospective cohort of people who were homeless during the COVID-19 pandemic

Loubiere,

Hafrad,

Monfardini

et al. 2023

Front. Public Health

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IntroductionCertain living conditions, such as homelessness, increase health risks in epidemic situations. We conducted a prospective observational cohort study to investigate the impact of the COVID-19 pandemic on morbidity and mortality in adult people who were homeless.MethodsThe study population comprised around 40% of the entire population experiencing homelessness in Marseille. They were enrolled at 48 different locations during the first pandemic wave (June to August 2020) and were followed up 3 and 6 months later. Rapid serological screening for SARS-CoV-2 was performed by community outreach teams at each follow-up, who also conducted interviews. Death registers and hospital administrative databases were consulted.ResultsA total of 1,332 participants [mean age 40.1 years [SD 14.2], women 339 (29.9%)] were enrolled in the cohort. Of these, 192 (14.4%) participants were found positive for COVID-19 and were propensity score matched (1:3) and compared with 553 non-COVID-19 cases. Living in emergency shelters was associated with COVID-19 infection. While 56.3% of the COVID-19-infected cohort reported no symptoms, 25.0% were hospitalized due to the severity of the disease. Presence of three or more pre-existing comorbidities was associated with all-cause hospitalization. Among COVID-19 cases, only older age was associated with COVID-19 hospitalization. Three deaths occurred in the cohort, two of which were among the COVID-19 cases.ConclusionThe study provides new evidence that the population experiencing homelessness faces higher risks of infection and hospitalization due to COVID-19 than the general population. Despite the efforts of public authorities, the health inequities experienced by people who are homeless remained major. More intensive and appropriate integrated care and earlier re-housing are needed.

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Expiring Eviction Moratoriums and COVID-19 Incidence and Mortality

et al. 2020

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Pandemic Housing Policy: Examining the Relationship Among Eviction, Housing Instability, Health Inequity, and COVID-19 Transmission

Cited by 3 publications

References 68 publications

Quantifying Inequities in COVID-19 Vaccine Distribution Over Time by social vulnerability, race and ethnicity, and location: A Population-Level Analysis in St. Louis and Kansas City, Missouri

Quantifying Inequities in COVID-19 Vaccine Distribution Over Time by social vulnerability, race and ethnicity, and location: A Population-Level Analysis in St. Louis and Kansas City, Missouri

Morbidity and mortality in a prospective cohort of people who were homeless during the COVID-19 pandemic

Expiring Eviction Moratoriums and COVID-19 Incidence and Mortality

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