Published 26 October 2009, doi:10.1136/bmj.b4036
Cite this as: BMJ 2009;339:b4036

Research

Mortality among residents of shelters, rooming houses, and hotels in Canada: 11 year follow-up study

¹ Centre for Research on Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada, ² Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ³ Health Information and Research Division, Statistics Canada, Ottawa, ⁴ Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ⁵ Health Information and Research Division, Statistics Canada, Toronto, ⁶ Dalla Lana School of Public Health, University of Toronto, Toronto, ⁷ Department of Population, Reproductive and Family Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, ⁸ Department of Geography and Programme in Planning, University of Toronto, Toronto, ⁹ Successful Societies Program, Canadian Institute for Advanced Research, Toronto, ¹⁰ Department of Health, Aging and Society, McMaster University, Hamilton, ON

Objective To examine mortality in a representative nationwide sample of homeless and marginally housed people living in shelters, rooming houses, and hotels.

Design Follow-up study.

Setting Canada 1991-2001.

Participants 15 100 homeless and marginally housed people enumerated in 1991 census.

Main outcome measures Age specific and age standardised mortality rates, remaining life expectancies at age 25, and probabilities of survival from age 25 to 75. Data were compared with data from the poorest and richest income fifths as well as with data for the entire cohort

Results Of the homeless and marginally housed people, 3280 died. Mortality rates among these people were substantially higher than rates in the poorest income fifth, with the highest rate ratios seen at younger ages. Among those who were homeless or marginally housed, the probability of survival to age 75 was 32% (95% confidence interval 30% to 34%) in men and 60% (56% to 63%) in women. Remaining life expectancy at age 25 was 42 years (42 to 43) and 52 years (50 to 53), respectively. Compared with the entire cohort, mortality rate ratios for men and women, respectively, were 11.5 (8.8 to 15.0) and 9.2 (5.5 to 15.2) for drug related deaths, 6.4 (5.3 to 7.7) and 8.2 (5.0 to 13.4) for alcohol related deaths, 4.8 (3.9 to 5.9) and 3.8 (2.7 to 5.4) for mental disorders, and 2.3 (1.8 to 3.1) and 5.6 (3.2 to 9.6) for suicide. For both sexes, the largest differences in mortality rates were for smoking related diseases, ischaemic heart disease, and respiratory diseases.

Conclusions Living in shelters, rooming houses, and hotels is associated with much higher mortality than expected on the basis of low income alone. Reducing the excessively high rates of premature mortality in this population would require interventions to address deaths related to smoking, alcohol, and drugs, and mental disorders and suicide, among other causes.

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