A tent is set up at a street corner in downtown Toronto.

Patients experiencing homelessness are 14 to 18 times more likely to visit emergency departments (EDs) in Toronto for cold weather-related injuries compared to non-homeless patients, according to a new study from Unity Health Toronto and ICES. The findings highlight the need to increase the number and accessibility of winter services throughout the cold season to prevent future injuries and lessen the strain on city emergency departments, the researchers say.

The study, led by researchers at MAP Centre for Urban Health Solutions and published in The Canadian Journal of Emergency Medicine, also found that women experiencing homelessness had consistently higher burden of cold-related injuries compared to men experiencing homelessness, relative to their housed counterparts.

 “Injuries related to cold exposure are to some extent an unavoidable reality in Canada, but the sheer excess burden among those experiencing homelessness is largely preventable,” said Lucie Richard, senior research associate at MAP and study lead author. “Providing adequate, accessible emergency warming services is not only a compassionate imperative, it’s also necessary to prevent major health-related consequences of cold weather-related injury including nerve damage, amputation, or loss of life.”

Dr. Carolyn Snider, chief of emergency medicine at St. Michael’s Hospital, said the study highlights a significant health consequence associated with the lack of access to round-the-clock shelter, particularly in adverse weather conditions. “The distressing effects on patients observed in our emergency departments in Canada are deeply worrisome – especially as they are preventable,” she said.

The research team analyzed all visits to 18 Toronto-based EDs between July 1, 2018 to June 30, 2022 using linked health administrative data housed at ICES. Patients who visited these EDs were classified in two groups: 1) patients experiencing homelessness and 2) patients not experiencing homelessness. The groups were further subdivided by sex.

For each winter season, the team identified within each group the number and rate per 100,000 visits of encounters with a cold weather-related injury diagnosis, which included outcomes such as frostbite and hypothermia. The team then calculated the ratio of rates between groups to estimate excess burden.

The authors note that their methodology likely resulted in some underestimation of the extent of the issue.

“Our findings make clear that much room exists to address cold weather-related injuries among this patient group. Unfortunately, emergency medicine clinicians are not in a position to treat the key underlying risk factor: homelessness,” said Richard.

“Municipal, provincial and federal governments all have a shared responsibility to provide alternative means to shelter from the cold. In an emergency setting, that means short-term shelter and warming options, but ultimately it means vastly expanding affordable housing.”

Media inquiries: Communications@unityhealth.to 

About MAP Centre for Urban Health

MAP is a world-leading research centre dedicated to creating a healthier future for all. Through big-picture research and street-level solutions, our scientists tackle complex community health issues — many at the intersection of health and equity. Internationally recognized for groundbreaking science and innovation, MAP has changed the way the world understands the health consequences of social inequality in Canada. Together with our community and policy partners, MAP is charting the way to the world’s healthiest cities: places where people, communities, and the political, economic, social, environmental and health infrastructures come together so that everyone can thrive. MAP is part of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and is fully affiliated with the University of Toronto. St. Michael’s is a site of Unity Health Toronto, which also includes Providence Healthcare and St. Joseph’s Health Centre. For more information visit: https://maphealth.ca/who-we-are/

About ICES

ICESis an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, visit www.ices.on.ca.