Care-seeking correlates of acute respiratory illness among sheltered homeless adults in Seattle, WA: a community-based cross-sectional study

Objectives: To evaluate viral respiratory infection and health care seeking behavior in sheltered homeless individuals, and assess factors that may impact the decision to seek care for acute respiratory illness (ARI).
Methods: This was a prospective cross-sectional surveillance study of 825 participant encounters from 649 unique participants. Enrollments took place between January 2019 and May 2019. The primary outcome was having sought health care from a medical provider, through self-report, for their current ARI episode. Adjusted logistic regression models were used to explore various self-reported clinical and demographic exposures as correlates of having sought health care.
Results: A total of 241 (29.2%) participant encounters reported having sought health care for their ARI episode. Those with chronic lung conditions were 55% more likely to have sought health care and smokers were 35% less likely. Those that reported experiencing influenza-like-illness symptoms were 63% more likely to have sought health care when compared to those with other symptom profiles. Having received an influenza vaccine (aPR 1.39, 95% CI 1.02 – 1.88) and having health insurance (aPR 2.77, CI 95% 1.27 – 6.02) were associated with increased likelihood of seeking health care.
Conclusion: Early identification of viral respiratory illness in homeless populations may be hindered by a lack of prior engagement with primary health care services. Interventions that target screening and on-site testing for early detection of viral ARI episodes and linkage to care with health services before viral shedding peaks is recommended in shelter settings.