292: THE IMPACT OF COVID-19 ON ICU UTILIZATION AND OUTCOMES OF CRITICALLY ILL HOMELESS PATIENTS

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Introduction: Recent data suggest a rise in ICU utilization among homeless patients. The COVID-19 pandemic has strained healthcare resources, with decreases of non-COVID-19 ICU admissions, and with possibly worse outcomes among the latter. However, the population-level impact of the COVID-19 pandemic on ICU utilization among homeless hospitalizations and outcomes of critically ill homeless patients is unknown. Methods: We used a statewide dataset to identify homeless hospitalizations aged ≥18 years in Texas during April 1-December 31, for each year of 2016-2020 (to align each year with the date of introduction of COVID-19-specific ICD-10 code [U07.1] in the United States). Homelessness was identified by ICD-10 code Z59.0. Hierarchical, mixed-effects negative binomial regression models were fit using the 2016-2019 data to forecast the number of ICU admissions among homeless hospitalizations in 2020, with changes expressed as annual percent change (APC). We then compared the number of observed and predicted ICU admissions. We used hierarchical, mixed-effects logistic regression models to estimate change in short-term mortality (defined as in-hospital death or discharge to hospice) in 2020 vs 2019 among homeless ICU admissions, overall and among those without COVID-19. Results: There were 47,288 homeless hospitalizations during 2016-19, with 31.5% admitted to ICU. There was no change in the rate of ICU admissions from 2016 to 2019 (APC -0.9 (95% CI -2.3 to +0.6). The observed and predicted numbers of homeless ICU admissions in 2020 was 4,785 (with COVID-19 in 7.3%) vs 4,811 (95% CI 4,631-4,990). Short-term mortality among ICU admissions in 2019 and 2020 was 3.4% vs 4.1% overall (3.8% in non-COVID-19). On adjusted analyses, the risk of short-term mortality among homeless ICU admissions in 2020 was higher than in 2019, overall (adjusted odds ratio [aOR] 1.46 [95% CI 1.12-1.90]) and among non-COVID patients (aOR 1.34 [95% CI 1.02-1.76]). Conclusions: Admission to ICU was common among homeless hospitalizations, but did not change significantly in 2020. Short-term mortality among homeless ICU admissions was generally low, but increased considerably in 2020, overall and among those without COVID-19.

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