Invasive Streptococcal Infections in People Experiencing Homelessness in Metro Atlanta—Georgia, 2010–2022 Restricted; Files Only
Scott, Sarah (Spring 2025)
Abstract
Background
People experiencing homelessness (PEH) are disproportionately affected by infectious diseases compared to the general population (non-PEH). In the western US, PEH account for a disproportionate number of invasive pneumococcal disease (IPD) and invasive group A Streptococcus (IGAS) cases; elsewhere, disparities in IPD and IGAS by housing status and whether an association between housing status and death exists are not well-documented.
Methods
Hospitalized IPD and IGAS cases in adult (≥18 years) Atlanta residents during 2010–2022 were ascertained from Georgia Emerging Infections Program (EIP) data. Duplicate cases (>1 case in one person in the same calendar year) were excluded. Probabilistic linkage of EIP data and Georgia death certificate records by first/last name, birthdate, and sex was performed. The EIP homelessness definition was used, which expanded to include unstable housing in 2019. Death was having a date of death ≤60 days after diagnosis in EIP or death certificate data. Person- and case-level characteristics by housing status were calculated. Annual age-adjusted incidence and ratios by housing status and 95% confidence intervals (CI) were estimated using Poisson regression. The association between housing status and death was estimated using crude and adjusted (age, any underlying medical condition) logistic regression.
Results
During 2010–2022, there were 4665 IPD cases (2.6% in PEH) in 4551 people (2.4% PEH) and 1999 IGAS cases (3.5% in PEH) in 1979 people (3.4% PEH). PEH with IPD or IGAS were younger (median age: IPD 44.5 vs. 55 years; IGAS 52 vs. 60 years) and more likely to lack insurance ([IPD: PEH%/non-PEH%; IGAS: PEH%/non-PEH%] 49.6%/14.1%; 60.3%/14.5%), use injection (6.3%/0.4%; 26.5%/1.9%) and non-injection (30.6%/9.8%; 41.2%/11.6%) drugs, and have HIV/AIDS (46.0%/11.0%; 11.8%/5.1%). IPD and IGAS incidence among PEH increased before and after the homeless definition expansion; among non-PEH, IPD incidence decreased and IGAS incidence was stable. There was no association between housing status and death.
Conclusions
Differences in person-level characteristics in IPD and IGAS cases by housing status likely reflect underlying population-level differences. PEH are disproportionately impacted by IPD and IGAS in Atlanta, which may be worsening. Housing status and death were not associated. PEH should be considered in targeted IPD and IGAS prevention efforts.
Table of Contents
Introduction/Background.....1
Methods.....5
Results.....13
Discussion.....20
References.....27
Tables and Figures.....33
Table 1.....33
Table 2.....34
Table 3.....35
Table 4.....36
Table 5.....37
Table 6.....38
Table 7.....39
Table 8.....40
Table 9.....41
Table 10.....42
Table 11.....43
Figure 1.....44
Figure 2.....45
Figure 3.....46
Figure 4.....47
Figure 5.....48
Figure 6.....49
Figure 7.....50
Figure 8.....51
Figure 9.....52
Figure 10.....53
Figure 11.....54
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