# Association Between Housing Status and COVID-19 Severity, Morbidity, and Mortality in the United States: A Propensity Score-Matched Analysis of the National Inpatient Sample

## TL;DR

This study finds that people with unstable housing had lower in-hospital mortality and fewer complications from COVID-19 compared to those with stable housing.

## Contribution

The study reveals a counterintuitive finding that unstable housing is associated with better short-term outcomes for hospitalized COVID-19 patients.

## Key findings

- Patients with unstable housing had lower in-hospital mortality rates compared to those with stable housing.
- Individuals with unstable housing experienced fewer complications during hospitalization for COVID-19.
- The subgroup with unstable housing was more likely to leave the hospital against medical advice.

## Abstract

The influence of unstable housing on COVID-19 health outcomes remains inadequately elucidated in existing literature. Prevailing assumptions suggest that individuals with unstable housing are more likely to have limited access to healthcare services, exacerbated comorbid conditions, and suboptimal living environments. Utilizing the 2020 National Inpatient Sample, we conducted a retrospective analysis on a cohort of 3838305 patients diagnosed with COVID-19. Of these, 22550 (0.59%) were identified as residing under unstable housing conditions. Both multivariate regression and propensity score-matched analyses were employed to evaluate key outcomes: in-hospital mortality, complications, hospitalization charges, length of stay, and disposition statuses. Contrary to the extant literature on infectious diseases, our analysis unveiled that patients with unstable housing conditions had lower rates of in-hospital mortality and fewer complications compared to those with stable housing. Notwithstanding, the propensity of this subgroup to leave against medical advice poses unique challenges and introduces the potential for adverse outcomes. While the findings contribute nuanced perspectives, it is imperative to recognize that unstable housing continues to be a significant determinant of a constellation of long-term health issues, such as mental health disorders, substance use, and chronic illnesses. Consequently, targeted interventions are indispensable for enhancing the health trajectory of this vulnerable population, especially in the exigencies of the COVID-19 pandemic.