{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T11:06:19Z","timestamp":1789729579241,"version":"4.0.1"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T00:00:00Z","timestamp":1694649600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Certain 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The 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\u2009months 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1,332 participants [mean age 40.1\u2009years [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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The 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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.1233020","type":"journal-article","created":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T13:13:20Z","timestamp":1694697200000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Morbidity and mortality in a prospective cohort of people who were homeless during the COVID-19 pandemic"],"prefix":"10.3389","volume":"11","author":[{"given":"Sandrine","family":"Loubiere","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ikrame","family":"Hafrad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Monfardini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marine","family":"Mosnier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Bosetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Auquier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilie","family":"Mosnier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aur\u00e9lie","family":"Tinland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,9,14]]},"reference":[{"key":"ref1","unstructured":"2022"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e573","DOI":"10.1016\/S2468-2667(20)30235-8","article-title":"COVID-19: France grapples with the pragmatics of isolation","volume":"5","author":"Atlani-Duault","year":"2020","journal-title":"Lancet Public Health"},{"key":"ref3","unstructured":"2020"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1016\/j.maturitas.2020.04.004","article-title":"COVID-19: the forgotten priorities of the pandemic","volume":"136","author":"Mesa Vieira","year":"2020","journal-title":"Maturitas"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"103527","DOI":"10.1016\/j.ijdrr.2023.103527","article-title":"Should everyone in need be treated equally? A European survey of expert judgment on social vulnerability to floods and pandemics to validate multi-hazard vulnerability factors","volume":"85","author":"Fekete","year":"2023","journal-title":"Int J Disaster Risk Reduct"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"100829","DOI":"10.1016\/j.ssmph.2021.100829","article-title":"\u201cLocked down outside\u201d: perception of hazard and health resources in COVID-19 epidemic context among homeless people","volume":"15","author":"Allaria","year":"2021","journal-title":"SSM - Popul Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1080\/14036096.2018.1481142","article-title":"Homelessness as capability deprivation: a conceptual model","volume":"36","author":"Batterham","year":"2019","journal-title":"Hous Theory Soc"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e186","DOI":"10.1016\/S2468-2667(20)30053-0","article-title":"COVID-19: a potential public health problem for homeless populations","volume":"5","author":"Tsai","year":"2020","journal-title":"Lancet Public Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1597","DOI":"10.1186\/s12889-022-14023-w","article-title":"Chronic diseases and multi-morbidity in persons experiencing homelessness: results from a cross-sectional study conducted at three humanitarian clinics in Germany in 2020","volume":"22","author":"Lutchmun","year":"2022","journal-title":"BMC Public Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2585","DOI":"10.1016\/j.jacc.2018.02.077","article-title":"Cardiovascular disease and homelessness","volume":"71","author":"Baggett","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1177\/1359105313500246","article-title":"Being healthy in unhealthy places: health tactics in a homeless lifeworld","volume":"20","author":"Stolte","year":"2015","journal-title":"J Health Psychol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1001\/jama.2020.6887","article-title":"Prevalence of SARS-CoV-2 infection in residents of a large homeless shelter in Boston","volume":"323","author":"Baggett","year":"2020","journal-title":"JAMA"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"521","DOI":"10.15585\/mmwr.mm6917e1","article-title":"Assessment of SARS-CoV-2 infection prevalence in homeless shelters \u2014 four U.S. cities, march 27\u2013April 15, 2020","volume":"69","author":"Mosites","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"523","DOI":"10.15585\/mmwr.mm6917e2","article-title":"COVID-19 outbreak among three affiliated homeless service sites \u2014 King County, Washington, 2020","volume":"69","author":"Tobolowsky","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1048","DOI":"10.5811\/westjem.2020.7.48725","article-title":"Homeless shelter characteristics and prevalence of SARS-CoV-2. West","volume":"21","author":"Karb","year":"2020","journal-title":"J Emerg Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e0255498","DOI":"10.1371\/journal.pone.0255498","article-title":"Seroprevalence of SARS-CoV-2 antibodies among homeless people living rough, in shelters and squats: A large population-based study in France","volume":"16","author":"Loubiere","year":"2021","journal-title":"PLoS One"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1016\/j.ijid.2020.12.031","article-title":"Asymptomatic patients as a source of transmission of COVID-19 in homeless shelters","volume":"103","author":"Ralli","year":"2021","journal-title":"Int J Infect Dis"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e202","DOI":"10.1016\/S2468-2667(21)00001-3","article-title":"Seroprevalence and risk factors of exposure to COVID-19 in homeless people in Paris, France: a cross-sectional study","volume":"6","author":"Roederer","year":"2021","journal-title":"Lancet Public Health"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e065734","DOI":"10.1136\/bmjopen-2022-065734","article-title":"Cumulative incidence of SARS-CoV-2 infection within the homeless population: insights from a city-wide longitudinal study","volume":"13","author":"Mosnier","year":"2023","journal-title":"BMJ Open"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e240","DOI":"10.1016\/S2468-2667(22)00007-X","article-title":"The effect of social deprivation on the dynamic of SARS-CoV-2 infection in France: a population-based analysis","volume":"7","author":"Vandentorren","year":"2022","journal-title":"Lancet Public Health"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1093\/infdis\/jiab261","article-title":"Morbidity and mortality among adults experiencing homelessness hospitalized with COVID-19","volume":"224","author":"Cha","year":"2021","journal-title":"J Infect Dis"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.cmi.2020.08.002","article-title":"Homeless people hospitalized with COVID-19 in Brussels","volume":"27","author":"Schrooyen","year":"2021","journal-title":"Clin Microbiol Infect"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1520.e1","DOI":"10.1016\/j.cmi.2021.05.039","article-title":"Impact of the COVID-19 pandemic on the homeless: results from a retrospective closed cohort in France (March\u2013May 2020)","volume":"27","author":"Husain","year":"2021","journal-title":"Clin Microbiol Infect"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e2028195","DOI":"10.1001\/jamanetworkopen.2020.28195","article-title":"Clinical outcomes, costs, and cost-effectiveness of strategies for adults experiencing sheltered homelessness during the COVID-19 pandemic","volume":"3","author":"Baggett","year":"2020","journal-title":"JAMA Netw Open"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e221870","DOI":"10.1001\/jamanetworkopen.2022.1870","article-title":"Mortality among people experiencing homelessness in San Francisco during the COVID-19 pandemic","volume":"5","author":"Cawley","year":"2022","journal-title":"JAMA Netw Open"},{"key":"ref26","unstructured":"2005"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1926","DOI":"10.1111\/j.1532-5415.2008.01935.x","article-title":"A manual of guidelines to score the modified cumulative illness rating scale and its validation in acute hospitalized elderly patients: validation of modified CIRS guidelines","volume":"56","author":"Salvi","year":"2008","journal-title":"J Am Geriatr Soc"},{"key":"ref28","unstructured":"2022"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1186\/s13054-020-03290-x","article-title":"Sensitivity of point-of-care IgM and IgG test in critically ill patients with SARS-Cov-2","volume":"24","author":"Nguyen","year":"2020","journal-title":"Crit Care Lond Engl"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"114067","DOI":"10.1016\/j.jviromet.2021.114067","article-title":"Analytical performances of five SARS-CoV-2 whole-blood finger-stick IgG-IgM combined antibody rapid tests","volume":"290","author":"P\u00e9r\u00e9","year":"2021","journal-title":"J Virol Methods"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"2235","DOI":"10.1007\/s10096-021-04232-3","article-title":"Performance of 30 commercial SARS-CoV-2 serology assays in testing symptomatic COVID-19 patients","volume":"40","author":"Vauloup-Fellous","year":"2021","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"ref32","unstructured":"Vie publique: au coeur du d\u00e9bat fran\u00e7ais142\n            DelfraissyJF\n            Atlani-DuaultL\n            BenamouzigD\n            BouadmaL\n            CasanovaJL\n            CauchemezS\n          2020"},{"key":"ref33","unstructured":"115\n            DelfraissyJF\n            Atlani-DuaultL\n            BenamouzigD\n            BouadmaL\n            CasanovaJL\n            CauchemezS\n          2020"},{"key":"ref34","unstructured":""},{"key":"ref35","unstructured":"2020"},{"key":"ref36","unstructured":"2020"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: a practical and powerful approach to multiple testing","volume":"57","author":"Benjamini","year":"1995","journal-title":"J R Stat Soc Ser B Methodol"},{"key":"ref38","unstructured":"InfoCovidFrance: Key numbers and evolution of COVID-19 in France and worldwide"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1186\/s12879-021-06973-0","article-title":"Prevalence of SARS-Cov-2 antibodies and living conditions: the French national random population-based EPICOV cohort","volume":"22","author":"Warszawski","year":"2022","journal-title":"BMC Infect Dis"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"117","DOI":"10.17269\/s41997-021-00591-8","article-title":"Prevalence of SARS-CoV-2 infection among people experiencing homelessness in Toronto during the first wave of the COVID-19 pandemic","volume":"113","author":"Luong","year":"2022","journal-title":"Can J Public Health"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"e0267725","DOI":"10.1371\/journal.pone.0267725","article-title":"Trends in social exposure to SARS-Cov-2 in France","volume":"17","author":"Warszawski","year":"2022","journal-title":"PLoS One"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"3219","DOI":"10.3390\/ijerph19063219","article-title":"A scoping review of the health impact of the COVID-19 pandemic on persons experiencing homelessness in North America and Europe","volume":"19","author":"Corey","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref43","unstructured":"2021"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1016\/j.annepidem.2021.04.002","article-title":"Assessment of contact tracing for COVID-19 among people experiencing homelessness, salt Lake County health department, march\u2013may 2020","volume":"59","author":"Fields","year":"2021","journal-title":"Ann Epidemiol"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"S294","DOI":"10.2105\/AJPH.2013.301369","article-title":"A comprehensive assessment of health care utilization among homeless adults under a system of universal health insurance","volume":"103","author":"Hwang","year":"2013","journal-title":"Am J Public Health"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"e157","DOI":"10.1093\/cid\/ciac039","article-title":"Lower prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among people experiencing homelessness tested in outdoor encampments compared with overnight shelters: Denver, Colorado, June\u2013July 2020","volume":"75","author":"Rowan","year":"2022","journal-title":"Clin Infect Dis"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"e0279538","DOI":"10.1371\/journal.pone.0279538","article-title":"Use of health care services among people with Covid-19 symptoms in the first pandemic peak in France","volume":"17","author":"Pousson","year":"2022","journal-title":"PLoS One"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1186\/s12879-023-08037-x","article-title":"COVID-19 in the homeless population: a scoping review and meta-analysis examining differences in prevalence, presentation, vaccine hesitancy and government response in the first year of the pandemic","volume":"23","author":"Ahillan","year":"2023","journal-title":"BMC Infect Dis"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"2016","DOI":"10.1007\/s11606-022-07506-4","article-title":"Hospitalizations during the COVID-19 pandemic among recently homeless individuals: a retrospective population-based matched cohort study","volume":"37","author":"Liu","year":"2022","journal-title":"J Gen Intern Med"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"1657","DOI":"10.1186\/s12889-021-11687-8","article-title":"Homelessness during COVID-19: challenges, responses, and lessons learned from homeless service providers in Tippecanoe County, Indiana","volume":"21","author":"Rodriguez","year":"2021","journal-title":"BMC Public Health"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11524-020-00502-1","article-title":"Eviction, health inequity, and the spread of COVID-19: housing policy as a primary pandemic mitigation strategy","volume":"98","author":"Benfer","year":"2021","journal-title":"J Urban Health"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1177\/0275074020942062","article-title":"How local governments are caring for the homeless during the COVID-19 pandemic","volume":"50","author":"Benavides","year":"2020","journal-title":"Am Rev Public Adm"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"e0278459","DOI":"10.1371\/journal.pone.0278459","article-title":"Providing housing first services for an underserved population during the early wave of the COVID-19 pandemic: a qualitative study","volume":"17","author":"Mejia-Lancheros","year":"2022","journal-title":"PLoS One"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1038\/s43856-023-00257-1","article-title":"Estimating COVID-19 vaccine uptake and its drivers among migrants, homeless and precariously housed people in France","volume":"3","author":"Roederer","year":"2023","journal-title":"Commun Med"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1233020\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T13:13:24Z","timestamp":1694697204000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1233020\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,14]]},"references-count":54,"alternative-id":["10.3389\/fpubh.2023.1233020"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2023.1233020","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,14]]},"article-number":"1233020"}}