Race and Ethnicity and Sex Variation in COVID-19 Mortality Risks Among Adults Experiencing Homelessness in Los Angeles County, California.
Race and Ethnicity and Sex Variation in COVID-19 Mortality Risks Among Adults Experiencing Homelessness in Los Angeles County, California.
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DOI：
10.1001/jamanetworkopen.2022.45263
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发表时间：
2022-12-01
影响因子：
13.8
通讯作者：
Kuhn, Randall
中科院分区：
文献类型：
--
作者：
Porter, Natalie A. C.;Brosnan, Hannah K.;Chang, Alicia H.;Henwood, Benjamin F.;Kuhn, Randall
在洛杉矶，无家可归者（PEH）与普通人群在新冠死亡率方面是否因种族、族裔和性别而存在差异？
在这项横断面研究中，在所有种族、族裔和性别群体中，感染新冠的无家可归者比普通人群面临更高的新冠死亡风险。白人无家可归者相较于其普通人群对应群体的死亡相对风险高于黑人和西班牙裔无家可归者。女性无家可归者的相对风险高于男性无家可归者。
这项研究的结果提供了证据，表明感染新冠的无家可归者存在过高的新冠死亡风险，并进一步加深了我们对无家可归与种族、族裔和性别之间交叉关联的理解。
很少有研究使用精确的年龄特异性数据来构建无家可归者与普通人群新冠死亡相对风险（RRs）的年龄标准化估计值，并且到目前为止，没有研究涉及感染新冠的无家可归者中新冠死亡率的种族、族裔和性别差异。
为了测量无家可归者与普通人群总体以及按性别、种族和族裔划分的年龄标准化死亡率比率。
在这项横断面研究中，使用5岁年龄组计算了每10万人中粗略的和特定年龄的新冠死亡率，并计算了25岁及以上无家可归者和普通人群的标准化死亡率，评估了从2020年1月1日到2021年11月1日按种族、族裔和性别划分的差异。死亡率和人口估计数来自洛杉矶县公共卫生部进行的新冠强制病例报告、年度无家可归者即时点数以及美国人口普查。
主要结果是来自临床医生报告、死亡证明、法医报告和生命记录死亡的新冠死亡病例。无家可归者身份是根据美国住房和城市发展部在新冠诊断或症状出现时对无家可归的定义确定的。
研究人群包括估计6382402名普通人群中的25441例死亡和估计52015名无家可归者中的256例死亡。无家可归者样本的种族和族裔情况如下：15539名黑人（29.9%），18057名西班牙裔（34.7%），14871名女性（28.6%），37007名男性（71.3%），3380名65岁及以上（6.5%），而估计的6382402名普通人群中，有591003名黑人（9.3%），2854842名西班牙裔（44.7%），3329765名女性（52.2%），3052637名男性（47.8%），1190979名65岁及以上（18.7%）。无家可归者的粗死亡率为0.49%，普通人群为0.40%，但无家可归者特定年龄的新冠死亡风险比普通人群高2.35倍（95%置信区间，2.08 - 2.66）。与普通人群中的对应群体相比，黑人无家可归者（RR，1.69；95%置信区间，1.31 - 2.18）、西班牙裔无家可归者（RR，2.34；95%置信区间，1.96 - 2.79）、白人无家可归者（RR，8.33；95%置信区间，6.37 - 10.88）、女性无家可归者（RR，3.39；95%置信区间，2.56 - 4.48）和男性无家可归者（RR，1.74；95%置信区间，1.52 - 2.00）与无家可归者身份相关的风险显著。
这项对感染新冠的无家可归者新冠死亡率的横断面研究提供了证据，表明与普通人群相比，无家可归者年龄调整后的新冠死亡风险过高。这项研究进一步加深了对无家可归与种族、族裔之间交叉关联的理解，因为观察到无家可归者的死亡率较高，但种族差异比普通人群更窄。
这项横断面研究考察了感染新冠的无家可归者与普通人群相比，死亡率在种族、族裔和性别方面的差异。
Did COVID-19 mortality differ between people experiencing homelessness (PEH) in Los Angeles and the general population by race and ethnicity and sex? In this cross-sectional study, PEH with COVID-19 infection experienced a higher risk of COVID-19 mortality than the general population among all racial and ethnic and sex groups. White PEH had greater relative risk of mortality vs their general population counterparts than Black and Hispanic PEH. Female PEH had greater relative risk than male PEH. The findings of this study provide evidence suggesting excess risk of COVID-19 fatality among PEH with COVID-19 infection and further our understanding of the intersectional association between homelessness and race and ethnicity and sex. Few studies have used precise age-specific data to construct age-standardized estimates of the relative risks (RRs) of COVID-19 mortality for people experiencing homelessness (PEH) vs the general population, and none to date has addressed race and ethnicity and sex variations in COVID-19 mortality among PEH with COVID-19 infection. To measure age-standardized mortality rate ratios for PEH vs the general population overall and by sex and race and ethnicity. In this cross-sectional study, crude and age-specific COVID-19 mortality rates per 100 000 people were calculated using 5-year age groups and standardized mortality ratios for PEH and the general population aged 25 years and older, assessing differences by race and ethnicity and sex, from January 1, 2020, to November 1, 2021. Mortality and population estimates came from COVID-19 mandatory case reporting conducted by the Los Angeles County Department of Public Health, the annual point-in-time homeless count, and the US Census. The main outcome was COVID-19 deaths sourced from clinician reports, death certificates, medical examiner reports, and vital records deaths. PEH status was determined using the US Department of Housing and Urban Development definitions for homelessness at the time of COVID-19 diagnosis or symptom onset. The study population included 25 441 deaths among an estimated 6 382 402 general population individuals and 256 deaths among an estimated 52 015 PEH. The race and ethnicity of the PEH sample was as follows: 15 539 Black (29.9%), 18 057 Hispanic (34.7%), 14 871 female (28.6%), 37 007 male (71.3%), and 3380 aged 65 years or older (6.5%), compared with the estimated general population of 6 382 402, which was 591 003 Black (9.3%), 2 854 842 Hispanic (44.7%), 3 329 765 female (52.2%), 3 052 637 male (47.8%), and 1 190 979 aged 65 years or older (18.7%). Crude death rates were 0.49% for PEH and 0.40% for the general population, but PEH experienced age-specific COVID-19 mortality risk 2.35 (95% CI, 2.08-2.66) times higher than the general population. There was significant risk associated with PEH status compared with their counterparts in the general population for Black PEH (RR, 1.69; 95% CI, 1.31-2.18), Hispanic PEH (RR, 2.34; 95% CI, 1.96-2.79), White PEH (RR, 8.33; 95% CI, 6.37-10.88), female PEH (RR, 3.39; 95% CI, 2.56-4.48), and male PEH (RR, 1.74; 95% CI, 1.52-2.00). This cross-sectional study of COVID-19 mortality among PEH with COVID-19 infection provides evidence suggesting excess risk of age-adjusted COVID-19 mortality among PEH compared with the general population. This study furthers understanding of the intersectional association between homelessness and race and ethnicity, as higher levels of mortality but narrower racial disparities among PEH than in the general population were observed. This cross-sectional study examines variation by race, ethnicity, and sex of mortality rates of people experiencing homelessness who develop COVID-19 compared with the general population.
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