Cold-related injuries in a cohort of homeless adults

ABSTRACT

People experiencing homelessness have an increased risk of cold-related injuries. This study determined the rate of emergency department (ED) visits for cold-related injuries among homeless adults and low-income controls in Toronto, Canada. Homeless individuals were recruited at shelters and meal programs. Age- and sex-matched controls living in low-income neighborhoods were selected. ED utilization was ascertained over 4-years of follow-up (2005–9) using administrative databases. A total of 16 ED visits for cold-related injuries were observed among 587 homeless men and 296 homeless women. The rate of ED visits was 6.7 (95% CI, 4.2–12.4) per 1000 person-years of observation among homeless men and 0.9 (95% CI, 0.03–5.6) among homeless women. ED visit rates were significantly higher among homeless men compared to low-income men (P < 0.001) and significantly higher among homeless men compared to homeless women (P = 0.03). Targeted public health interventions are needed to reduce the risk of cold-related injuries among people experiencing homelessness.

KEYWORDS:

• Homeless persons
• cold temperature
• environmental exposure

Subject classification codes:

• Homelessness
• epidemiology

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Paige Zhang is a Psychiatry resident physician at the University of British Columbia in Vancouver, Canada. She received a BSc in Honors Physiology from the University of British Columbia.

Kate Bassil is Acting Director of the Healthy Public Policy Directorate at Toronto Public Health in Toronto, Canada. She received her PhD and MSc in Epidemiology from the University of Toronto, and holds an adjunct appointment at the University of Toronto’s Dalla Lana School of Public Health. She has a variety of experience in applied health research and healthy public policy, particularly in the area of environmental health.

Stephanie Gower is a research and policy specialist in the Healthy Public Policy Team at Toronto Public Health. She received her PhD in Health Studies from the University of Waterloo, and holds an adjunct appointment at the University of Toronto’s Dalla Lana School of Public Health. Her current work supporting a healthier Toronto focuses on health impacts of air pollution and climate change, and on interactions between health and Toronto’s built environment.

Marko Katic was a biostatistician at the Institute for Clinical Evaluative Sciences in Toronto, Canada.

Alex Kiss is the head of the Department of Research Design and Biostatistics at Sunnybrook Research Institute and an adjunct scientist at the Institute for Clinical Evaluative Sciences in Toronto, Canada. He received his PhD in Biostatistics from Columbia University, and is an Assistant Professor in the Department of Health Policy, Management and Evaluation at the University of Toronto. His research is focused on the design and analysis of studies ranging from clinical trials to observational studies, specializing in techniques inherent to survival analysis and hierarchical modeling.

Evie Gogosis is a research coordinator at the Centre for Urban Health Solutions at St. Michael’s Hospital in Toronto, Canada. She received her MSW from the University of Toronto’s Factor-Inwentash Faculty of Social Work. Her research focuses on the health of people experiencing homelessness and housing vulnerability.

Stephen Hwang is a Professor of Medicine at the University of Toronto and a practicing physician in general internal medicine at St. Michael’s Hospital in Toronto, Canada. He is the Director of the Centre for Urban Health Solutions at St. Michael’s Hospital and holds the Chair in Homelessness, Housing, and Health at the University of Toronto and St. Michael’s Hospital. Dr. Hwang’s research focuses on health conditions and access to health care among people experiencing homelessness, the connections between housing and health, and interventions to improve the health of people who are homeless.

ORCID

Paige Zhang http://orcid.org/0000-0002-8727-149X

Additional information

Funding

This project was supported by grants from the Agency for Healthcare Research and Quality (1 R01 HS014129-01) and the Canadian Institutes of Health Research (MOP-62736). This study was supported by the Institute for Clinical Evaluative Sciences which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the article. The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred.