Vaccine Effectiveness Against SARS-CoV-2 Related Hospitalizations in People who had Experienced Homelessness or Incarceration – Findings from the Minnesota EHR Consortium

Malini B. DeSilva, Gregory Knowlton, Nayanjot K. Rai, Peter Bodurtha, Inih Essien, John Riddles, Lemlem Mehari, Miriam Muscoplat, Ruth Lynfield, Elizabeth A.K. Rowley, Alanna M. Chamberlain, Palak Patel, Alexandria Hughes, Monica Dickerson, Mark G. Thompson, Eric P. Griggs, Mark Tenforde, Tyler N.A. Winkelman, Gabriela Vazquez Benitez, Paul E. Drawz

Research output: Contribution to journalArticlepeer-review


COVID-19 disproportionately affects people experiencing homelessness or incarceration. While homelessness or incarceration alone may not impact vaccine effectiveness, medical comorbidities along with social conditions associated with homelessness or incarceration may impact estimated vaccine effectiveness. COVID-19 vaccines reduce rates of hospitalization and death; vaccine effectiveness (VE) against severe outcomes in people experiencing homelessness or incarceration is unknown. We conducted a retrospective, observational cohort study evaluating COVID-19 vaccine VE against SARS-CoV-2 related hospitalization (positive SARS-CoV-2 molecular test same week or within 3 weeks prior to hospital admission) among patients who had experienced homelessness or incarceration. We utilized data from 8 health systems in the Minnesota Electronic Health Record Consortium linked to data from Minnesota’s immunization information system, Homeless Management Information System, and Department of Corrections. We included patients 18 years and older with a history of experiencing homelessness or incarceration. VE and 95% Confidence Intervals (CI) against SARS-CoV-2 hospitalization were estimated for primary series and one booster dose from Cox proportional hazard models as 100*(1-Hazard Ratio) during August 26, 2021, through October 8, 2022 adjusting for patient age, sex, comorbid medical conditions, and race/ethnicity. We included 80,051 individuals who had experienced homelessness or incarceration. Adjusted VE was 52% (95% CI, 41–60%) among those 22 weeks or more since their primary series, 66% (95% CI, 53–75%) among those less than 22 weeks since their primary series, and 69% (95% CI: 60–76%) among those with one booster. VE estimates were consistently lower during the Omicron predominance period compared with the combined Omicron and Delta periods. Despite higher exposure risk, COVID-19 vaccines provided good effectiveness against SARS-CoV-2 related hospitalizations in persons who have experienced homelessness or incarceration.

Original languageEnglish (US)
Pages (from-to)448-457
Number of pages10
JournalJournal of Community Health
Issue number3
StatePublished - Jun 2024

Bibliographical note

Publisher Copyright:
© The Author(s) 2023.


  • COVID-19
  • COVID-19 Vaccines
  • Homelessness
  • Minnesota

PubMed: MeSH publication types

  • Observational Study
  • Journal Article


Dive into the research topics of 'Vaccine Effectiveness Against SARS-CoV-2 Related Hospitalizations in People who had Experienced Homelessness or Incarceration – Findings from the Minnesota EHR Consortium'. Together they form a unique fingerprint.

Cite this