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BRIEF RESEARCH REPORT article

Front. Public Health
Sec. Life-Course Epidemiology and Social Inequalities in Health
Volume 12 - 2024 | doi: 10.3389/fpubh.2024.1401662

Disparities in all-cause mortality among people experiencing homelessness in Toronto, Canada during the COVID-19 pandemic: a cohort study

Provisionally accepted
Lucie Richard Lucie Richard 1*Brooke Carter Brooke Carter 2Linda Wu Linda Wu 3Stephen W. Hwang Stephen W. Hwang 1,4,5,6
  • 1 MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
  • 2 ICES Western, London, Canada
  • 3 Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
  • 4 ICES, Toronto, Canada
  • 5 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  • 6 Department of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada

The final, formatted version of the article will be published soon.

    People experiencing homelessness have historically had high mortality rates compared to housed individuals in Canada, a trend believed to have become exacerbated during the COVID-19 pandemic. In this matched cohort study conducted in Toronto, Canada, we investigated all-cause mortality over a one-year period by following a random sample of people experiencing homelessness (n=640) alongside matched housed (n=6,400) and low-income housed (n=6,400) controls. Matching criteria included age, sex-assigned-at-birth, and Charlson comorbidity index. Data were sourced from the Ku-gaa-gii pimitizi-win cohort study and administrative databases from ICES. People experiencing homelessness had 2.7 deaths/100 person-years, compared to 0.7/100 person-years in both matched control groups, representing an all-cause mortality unadjusted hazard ratio (uHR) of 3.7 (95% CI, 2.1-6.5). Younger homeless individuals had much higher uHRs than older groups (ages 25-44 years uHR 16.8 [95% CI 4.0-70.2]; ages 45-64 uHR 6.8 [95% CI 3.0-15.1]; ages 65+ uHR 0.35 [95% CI 0.1-2.6]). Homeless participants who died were, on average, 17 years younger than controls. After adjusting for number of comorbidities and presence of mental health or substance use disorder, people experiencing homelessness still had more than twice the hazard of death (aHR 2.2 [95% CI 1.2-4.0]). Homelessness is an important risk factor for mortality; interventions to address this health disparity, such as increased focus on homelessness prevention, are urgently needed.

    Keywords: Homelessness, Mortality, COVID-19 pandemic, Health Disparities, Health Services Research

    Received: 15 Mar 2024; Accepted: 23 Jul 2024.

    Copyright: © 2024 Richard, Carter, Wu and Hwang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Lucie Richard, MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.