1
|
Grune J, Savelsberg D, Kobus M, Lindner AK, Herrmann WJ, Schuster A. Determinants of COVID-19 vaccine acceptance and access among people experiencing homelessness in Germany: A qualitative interview study. Front Public Health 2023; 11:1148029. [PMID: 37033048 PMCID: PMC10081579 DOI: 10.3389/fpubh.2023.1148029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/28/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction People experiencing homelessness face lower life expectancy, higher prevalence of somatic and mental diseases and a more difficult access to healthcare compared to people in secure living. During the COVID-19 pandemic transmission rates were higher among people experiencing homelessness and preventive public health measures were not properly adapted to the specific needs of people experiencing homelessness. Thus, goal of our study was understanding the determinants of acceptability and access of the COVID-19 vaccine. Materials and methods We conducted a qualitative interview study with twenty guideline interviews with adult people currently experiencing homelessness in Berlin, Germany (August 2021 - April 2022). Participants were approached in a purposive sampling strategy. The interviews were analyzed with qualitative content analysis according to Mayring. Results Acceptance and attitude toward the COVID-19 vaccine is influenced by confidence in the vaccine as well as in the political and healthcare system, the individual COVID-19 risk perception and sense of collective responsibility. Overall, the acceptance of the vaccine was high among our participants. Facilities offering low threshold COVID-19 vaccines for people experiencing homelessness were perceived as helpful. Language barriers and the need for identity documents were major barriers to access the COVID 19 vaccine. Discussion People experiencing homelessness are a marginalized and vulnerable group often underrepresented in the public and scientific discourse. During the COVID-19 pandemic, preventive public health measures, including the COVID-19 vaccine, failed to consider specific needs of people experiencing homelessness. Multidimensional strategy to enhance inclusive healthcare are needed to improve access and to reduce discrimination and stigmatization.
Collapse
Affiliation(s)
- Julianna Grune
- Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- *Correspondence: Julianna Grune,
| | - Darius Savelsberg
- Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Marta Kobus
- Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Andreas K. Lindner
- Institute of International Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Wolfram J. Herrmann
- Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Angela Schuster
- Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| |
Collapse
|
2
|
Liu M, Richard L, Campitelli MA, Nisenbaum R, Dhalla IA, Wadhera RK, Shariff SZ, Hwang SW. Hospitalizations During the COVID-19 Pandemic Among Recently Homeless Individuals: a Retrospective Population-Based Matched Cohort Study. J Gen Intern Med 2022; 37:2016-2025. [PMID: 35396658 PMCID: PMC8992790 DOI: 10.1007/s11606-022-07506-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hospitalizations fell precipitously among the general population during the COVID-19 pandemic. It remains unclear whether individuals experiencing homelessness experienced similar reductions. OBJECTIVE To examine how overall and cause-specific hospitalizations changed among individuals with a recent history of homelessness (IRHH) and their housed counterparts during the first wave of the COVID-19 pandemic, using corresponding weeks in 2019 as a historical control. DESIGN Population-based cohort study conducted in Ontario, Canada, between September 30, 2018, and September 26, 2020. PARTICIPANTS In total, 38,617 IRHH, 15,022,368 housed individuals, and 186,858 low-income housed individuals matched on age, sex, rurality, and comorbidity burden. MAIN MEASURES Primary outcomes included medical-surgical, non-elective (overall and cause-specific), elective surgical, and psychiatric hospital admissions. KEY RESULTS Average rates of medical-surgical (rate ratio: 3.8, 95% CI: 3.7-3.8), non-elective (10.3, 95% CI: 10.1-10.4), and psychiatric admissions (128.1, 95% CI: 126.1-130.1) between January and September 2020 were substantially higher among IRHH compared to housed individuals. During the peak period (March 17 to June 16, 2020), rates of medical-surgical (0.47, 95% CI: 0.47-0.47), non-elective (0.80, 95% CI: 0.79-0.80), and psychiatric admissions (0.86, 95% CI: 0.84-0.88) were significantly lower among housed individuals relative to equivalent weeks in 2019. No significant changes were observed among IRHH. During the re-opening period (June 17-September 26, 2020), rates of non-elective hospitalizations for liver disease (1.41, 95% CI: 1.23-1.69), kidney disease (1.29, 95% CI: 1.14-1.47), and trauma (1.19, 95% CI: 1.07-1.32) increased substantially among IRHH but not housed individuals. Distinct hospitalization patterns were observed among IRHH even in comparison with more medically and socially vulnerable matched housed individuals. CONCLUSIONS Persistence in overall hospital admissions and increases in non-elective hospitalizations for liver disease, kidney disease, and trauma indicate that the COVID-19 pandemic presented unique challenges for recently homeless individuals. Health systems must better address the needs of this population during public health crises.
Collapse
Affiliation(s)
- Michael Liu
- Harvard Medical School, Boston, MA, USA. .,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. .,ICES Central, Toronto, Ontario, Canada.
| | | | | | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Irfan A Dhalla
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
3
|
Corey J, Lyons J, O’Carroll A, Stafford R, Ivers JH. A Scoping Review of the Health Impact of the COVID-19 Pandemic on Persons Experiencing Homelessness in North America and Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3219. [PMID: 35328907 PMCID: PMC8954292 DOI: 10.3390/ijerph19063219] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 02/04/2023]
Abstract
Persons experiencing homelessness (PEH) are at heightened risk for infection, morbidity, and mortality from COVID-19. However, health consequences of the pandemic extend far beyond those directly caused by the virus. This scoping review aimed to explore the impacts of the COVID-19 pandemic on the health and well-being of PEH in North America and Europe. A systematic search of academic and grey literature was conducted in September 2021. To be included, studies had to include primary data related to the impact of the pandemic on health or well-being of PEH and be written in English. All potentially relevant references were independently screened by two reviewers, and minor conflicts were settled with input of a third reviewer. A total of 96 articles met criteria for inclusion. Data extraction was completed for all included studies, and findings synthesised and presented thematically. Numerous health impacts of the pandemic on PEH were identified, including SARS-CoV-2 infection, morbidity, mortality, and hospitalisation, fear of infection, access to housing, hygiene, PPE, food, as well as mental health, substance use, other health-related outcomes and treatment services. Gaps in the literature relating to persons using alcohol, access to mental health support, and violence were also identified. Implications for future research are discussed.
Collapse
Affiliation(s)
- Julia Corey
- Department of Public Health & Primary Care, School of Medicine, Trinity College Dublin, D24H74 Dublin, Ireland; (J.C.); (J.L.)
| | - James Lyons
- Department of Public Health & Primary Care, School of Medicine, Trinity College Dublin, D24H74 Dublin, Ireland; (J.C.); (J.L.)
| | | | - Richie Stafford
- HSE Community Healthcare Organisation Dublin North City & County, D09C8P5 Dublin, Ireland;
| | - Jo-Hanna Ivers
- Department of Public Health & Primary Care, School of Medicine, Trinity College Dublin, D24H74 Dublin, Ireland; (J.C.); (J.L.)
| |
Collapse
|
4
|
Chen X, Su D, Chen X, Chen Y. Effect of informal care on health care utilisation for the elderly in urban and rural China: evidence from China health and retirement longitudinal study (CHARLS). BMC Health Serv Res 2022; 22:271. [PMID: 35232442 PMCID: PMC8887010 DOI: 10.1186/s12913-022-07675-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 02/23/2022] [Indexed: 02/03/2023] Open
Abstract
Background Receiving informal care from family members is the mainstream way of care for the elderly in China because of the influence of the culture of filial piety. However, the relationship between informal care and health care use in urban and rural areas needs to be further explored. This study aimed to understand the association between informal care and health care utilisation for the elderly and explore how this effect may differ between urban and rural China. Method A total of 5704 residents aged 65 years and above were selected from wave 3 (2015) and wave 4 (2018) of the China Health and Retirement Longitudinal Study, which is a nationally representative survey. A negative binomial regression model for the panel data was used to explore the relationship between informal care and health care utilisation. A fixed-effect binary choice model for panel data was used for the sensitivity test. Result The elderly who received informal care had increased in outpatient and inpatient visits compared with those who did not receive informal care. The inpatient visits of the elderly who received 15–29 days of informal care was higher than the elderly who did not receive informal care (incidence rate ratio [IRR] = 2.082, P < 0.05). Moreover, the elderly who received informal care for more than 30 days had 39.6% more inpatient visits (IRR = 1.396, P < 0.01) and 37.4% more outpatient visits than the elderly who did not receive informal care (IRR = 1.374, P < 0.05). For urban respondents, receiving informal care can facilitate outpatient use of the elderly, but for rural respondents, receiving informal care can predict an increase in outpatient and inpatient visits. Conclusion Informal care was associated with higher use of health services. The association between informal care and health care utilisation varies between rural and urban residents. These findings indicate the role of informal care and remind that relevant departments should pay attention to the differences in medical service utilisation levels amongst different elderly groups.
Collapse
Affiliation(s)
- Xinlan Chen
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Research Centre for Rural Health Service, Wuhan, 430030, China
| | - Dai Su
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Research Centre for Rural Health Service, Wuhan, 430030, China.,Department of Health Management and Policy, School of Public Health, Capital Medical University, Beijing, China
| | - Xinlin Chen
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Research Centre for Rural Health Service, Wuhan, 430030, China
| | - Yingchun Chen
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. .,Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Research Centre for Rural Health Service, Wuhan, 430030, China.
| |
Collapse
|
5
|
Aboutara N, Müller A, Jungen H, Szewczyk A, van Rüth V, Bertram F, Püschel K, Heinrich F, Iwersen-Bergmann S. Investigating the use of PEth, CDT and MCV to evaluate alcohol consumption in a cohort of homeless individuals- A comparison of different alcohol biomarkers. Forensic Sci Int 2021; 331:111147. [PMID: 34920332 DOI: 10.1016/j.forsciint.2021.111147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 12/28/2022]
Abstract
In a cohort including individuals with suspected high alcohol consumption, the concentrations of the indirect alcohol biomarkers carbohydrate-deficient transferrin (CDT) and mean corpuscular volume (MCV) and the direct alcohol biomarker phosphatidylethanol (PEth) were investigated. Blood alcohol concentration (BAC) was analysed as a marker for acute alcohol ingestion. In addition to questions about subjective alcohol consumption behaviour, 147 homeless persons underwent a physical examination with blood sampling. BAC, PEth, CDT and MCV were determined in the blood samples. Special focus was on the comparison of PEth and CDT for indicating excessive alcohol consumption. BAC was measured above 0.1‰ in 39 blood samples (0.1-2.5‰, median 0.75‰). PEth was detected in all of them. Overall, PEth was positive (≥10 ng/ml) in 104 samples (71%) (11-5687 ng/ml, median 650 ng/ml) with 68 (46%) being above the cut-off for excessive alcohol consumption (210 ng/ml). In 26 subjects PEth was the only positive alcohol biomarker. CDT was ≥ 1.7% in 66 cases (47%) (1.8-22.2%, median 4.4%) and ≥ 2.5% in 52 (35%) cases. MCV was elevated (≥95 fl) in 58 subjects (39%). CDT and PEth concentrations showed a significant positive correlation (spearman's correlation coefficient ρ = 0.77, p < 0.001). PEth concentrations were significantly higher in samples that were also CDT positive than solely PEth positive (p = 0.004). PEth did not indicate excessive alcohol consumption (< 210 ng/ml) in eight and two cases in which CDT was ≥ 1.7% and ≥ 2.5%, respectively. On the other hand, CDT was< 1.7% and< 2.5% in ten and 18 cases, respectively, in which PEth was above cut-off for excessive alcohol consumption. Taking the self-reports of the participants into consideration, PEth's sensitivity for detecting excessive alcohol consumption was 100% (10 ng/ml) and 94% (210 ng/ml) and CDT's was 88% (1.7%) and 75% (2.5%). In individuals of the investigated cohort unusually high concentrations of the alcohol consumption markers PEth and CDT were quantified, which proves the assumption of chronic excessive alcohol consumption in parts of the cohort. PEth was the marker that was positive most often and was more sensitive for excessive alcohol consumption than CDT.
Collapse
Affiliation(s)
- Nadine Aboutara
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany.
| | - Alexander Müller
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Hilke Jungen
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Anne Szewczyk
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Victoria van Rüth
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Franziska Bertram
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Klaus Püschel
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Fabian Heinrich
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| | - Stefanie Iwersen-Bergmann
- Department of Legal Medicine, University Medical Centre Hamburg-Eppendorf, Butenfeld 34, Hamburg 22529, Germany
| |
Collapse
|