Over the course of the Covid-19 pandemic, disparities in the risk of acquiring the virus have emerged. Infection rates and Covid-19 related deaths differ by gender, ethnicity, and socio-economic status. Yet, housing is a public health issue that often intersects with socio-economic status and other protected characteristics, with a large body of evidence linking poor housing conditions to worse health outcomes.

At the start of the Covid-19 pandemic there were concerns about the increased risk of infection, hospitalisation, and death amongst homeless populations [1]. Experiencing homelessness potentially means having to share space in temporary or unsuitable accommodation and in some cases, people may also lack sanitary conditions. People who are homeless may therefore face difficulties in social distancing, isolating when sick, and maintaining hand hygiene.

Studies of emergency shelters for people experiencing homelessness across the United States and in Paris suggest that overcrowding is associated with increased infection rates [2]. But, homelessness covers a breadth of experiences. Alongside people in shelters, homelessness can include being on the streets, staying with family or friends (‘sofa surfing’) or in overcrowded rented housing. Using data linkage, we aim to explore this broader group of people experiencing homelessness.

Using data linkage to explore homelessness and Covid-19 risk in Wales

Covid-19 test data for Wales has recently become available for approved researchers to access via the SAIL Databank. With access to this anonymised data, we intend to use Primary Care and other health data to identify people reporting homelessness in Wales. We will then create a matched comparison group based on age, gender and area characteristics. Covid-19 infection can then be compared between the homeless and matched groups.

This work will provide important retrospective analysis of Covid-19 infection rates amongst people who are homeless in Wales. Within the limits of the dataset, this will provide an indication of the extent to which measures taken in Wales may have impacted on the high levels of infection predicted amongst the homeless population.

This work will be carried out as part of ADR Wales Housing and Homelessness body of work using Covid-19 test data initially acquired by the ADR Wales team to assist the One Wales response to Covid-19 in Wales. One Wales brings together organisations from across Wales to provide expertise and rapid response analysis to aid understanding of the pandemic at Welsh Government Technical Advisory Group (TAG) and UK SAGE.

Find out more about ADR Wales’ Housing and Homelessness body of work.


[1] Lewer, D., Briathwaite, I., Bullock, M. et al., (2020) COVID-19 among people experiencing homelessness in England: a modelling study. The Lancet. 8:1181-1191.

[2] See for example: Karb, R., Samuels, E., Najani, R. et al., (2020) Homeless shelter characteristics and prevalence of SARS-CoV-2. Western Journal of Emergency Medicine. 21(5):1048-1053; Roederer, T., Mollow, B., Vincent, C. et al., (2021) Seroprevalence and risk factors of exposure to COVID-19 in homeless people in Paris, France: a cross-sectional study. Lancet Public Health. 6:e202-209.