Demographic Shifts in Pediatric Emergency Department Visits for Homelessness During State and Federal Policy Changes

To evaluate the trends, demographics, and visit characteristics in pediatric emergency department (ED) visits for homelessness in relation to state and federal policies before and during the COVID-19 pandemic.

We conducted a retrospective cohort study of pediatric ED visits for homelessness from 2019 to 2021 at an urban tertiary care children's hospital. Visit rates were analyzed in relation to the 2019 repeal of a restrictive shelter eligibility state policy and the implementation and expiration of state and federal COVID-19 eviction moratoria. Demographic and clinical characteristics were compared before and during the pandemic.

Among 1045 visits, the rate of pediatric ED visits for homelessness per 1000 total visits declined modestly after the 2019 policy repeal, then spiked in January 2021 following the end of COVID-19 eviction moratoria. During the pandemic, children presenting for homelessness were more likely to be Hispanic (72.5% vs 53.4%; P < .001), have Spanish-speaking caregivers (59.1% vs 40.1%; P < .001), and have chronic medical conditions (25.2% vs 14.6%; P < .001), compared with before the pandemic. Families were less likely to have eviction as the reason for their homelessness (6.2% vs 11.4%; P = .010) during the pandemic and were more likely to cite loss of job or income (11.2% vs 4.9%; P = .001).

Pediatric ED visits for homelessness persisted throughout the pandemic, with notable demographic shifts and changing causes of homelessness. These findings demonstrate the inequitable impact of the pandemic on different groups of children, underscore the limitations of temporary housing protections, and highlight the need for durable, equity-driven housing policies.