COVID-19 vaccine coverage and sociodemographic, behavioural and housing factors associated with vaccination among people experiencing homelessness in Toronto, Canada: a cross-sectional study

Abstract

People experiencing homelessness were prioritized for COVID-19 vaccination in Toronto, Canada, due to the high risk of infection and associated complications relative to the general population. We aimed to ascertain COVID-19 vaccine coverage in this population and explore factors associated with the receipt of at least one dose. We collected survey and blood sample data from individuals ages 16+ recruited by random selection at 62 shelters, hotels and encampment sites between 16 June 2021 and 9 September 2021. We report vaccine coverage by dose number and explored sociodemographic, behavioral, health and housing factors associated with vaccination using multivariable modified Poisson regression. In total, 80.4% (95% CI 77.3–83.1%) received at least one vaccine dose, and 63.6% (CI 60.0–67.0%) received two or more doses. Vaccination was positively associated with age (every 10 years adjusted rate ratio (aRR) 1.05 [95% CI 1.03–1.08]), and receipt of influenza vaccination (aRR 1.19 [95% CI 1.11–1.27]). Factors negatively associated with vaccination included female gender (aRR 0.92 [95% CI 0.85–1.0]), Black racial self-identification (aRR 0.89 [95% CI 0.80–0.99]) and low frequencies of masking in public places (aRR 0.83 [95% CI 0.72–0.95]). COVID-19 vaccine coverage is very high among people experiencing homelessness in Toronto, suggesting advocacy and outreach efforts may have been effective.