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Trends in emergency department visits during cold weather seasons among patients experiencing homelessness in Ontario, Canada: a retrospective population-based cohort study

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Canadian Journal of Emergency Medicine Aims and scope Submit manuscript

Abstract

Purpose

Recent anecdotal reports suggest increasing numbers of people experiencing homelessness are visiting emergency departments (EDs) during cold weather seasons due to inadequate shelter availability. We examined monthly ED visits among patients experiencing homelessness to determine whether there has been a significant increase in such visits in 2022/2023 compared to prior years.

Methods

We used linked health administrative data to identify cohorts experiencing homelessness in Ontario between October and March of the 2018/2019 to 2022/2023 years. We analyzed the monthly rate of non-urgent ED visits as a proxy measure of visits plausibly attributable to avoidance of cold exposure, examining rates among patients experiencing homelessness compared to housed patients. We excluded visits for overdose or COVID-19. We assessed level and significance of change in the 2022/2023 year as compared to previous cold weather seasons using Poisson regression.

Results

We identified a total of 21,588 non-urgent ED visits across the observation period among patients experiencing homelessness in Ontario. Non-urgent ED visits increased 27% (RR 1.24 [95% CI 1.14–1.34]) in 2022/2023 compared to previous cold weather seasons. In Toronto, such visits increased by 70% (RR 1.68 [95% CI 1.57–1.80]). Among housed patients, non-urgent ED visits did not change significantly during this time period.

Conclusion

Rates of ED visits plausibly attributable to avoidance of cold exposure by individuals experiencing homelessness increased significantly in Ontario in 2022/2023, most notably in Toronto. This increase in ED visits may be related to inadequate access to emergency shelter beds and warming services in the community.

Résumé

Objectifs

Des rapports anecdotiques récents suggèrent qu’un nombre croissant de personnes en situation d’itinérance visitent les services d’urgence (SU) pendant les saisons froides en raison de la disponibilité insuffisante d’hébergement d’urgence. Nous avons examiné les visites mensuelles aux urgences chez les personnes en situation d’itinérance afin de déterminer s’il y a eu une augmentation significative de ces visites en 2022-2023 par rapport aux années précédentes.

Méthodes

Nous avons utilisé des données administratives de santé liées pour identifier les cohortes de personnes en situation d’itinérance en Ontario entre octobre et mars des années 2018/2019 à 2022/2023. Nous avons analysé le taux mensuel de visites aux urgences non urgentes comme mesure approximative des visites vraisemblablement attribuables à l’évitement de l’exposition au froid, en examinant les taux chez les personnes en situation d’itinérance par rapport aux patients logés. Nous avons exclu les visites pour surdose ou COVID-19. Nous avons évalué le niveau et l’importance du changement dans l’année 2022/2023 par rapport aux saisons froides précédentes en utilisant la régression de Poisson.

Résultats

Nous avons recensé un total de 21 588 visites non urgentes aux urgences au cours de la période d’observation chez des personnes en situation d’itinérance en Ontario. Les visites aux urgences non urgentes ont augmenté de 27 % (RR 1,24 [IC à 95 % 1,14-1,34]) en 2022‑2023 par rapport aux saisons froides précédentes. À Toronto, ces visites ont augmenté de 70 % (RR 1,68 [IC à 95 % 1,57-1,80]). Parmi les patients logés, les visites aux urgences non urgentes n’ont pas changé de façon significative pendant cette période.

Conclusions

Les taux de visites aux urgences attribuables vraisemblablement à l’évitement de l’exposition au froid par les personnes en situation d’itinérance ont augmenté considérablement en Ontario en 2022–2023, surtout à Toronto. Cette augmentation du nombre de visites aux urgences peut être liée à un accès inadéquat aux lits des refuges d’urgence et aux services de réchauffement dans la collectivité.

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Data availability

The dataset from this study is held securely in coded form at ICES. While legal data sharing agreements between ICES and data providers (e.g., healthcare organizations and government) prohibit ICES from making the dataset publicly available, access may be granted to those who meet pre-specified criteria for confidential access, available at www.ices.on.ca/DAS (email: das@ices.on.ca). The full dataset creation plan and underlying analytic code are available from the authors upon request, understanding that the computer programs may rely upon coding templates or macros that are unique to ICES and are therefore either inaccessible or may require modification.

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Acknowledgements

This work was supported by the Applied Health Research Questions (AHRQ) Portfolio at ICES, which is funded by the Ontario Ministry of Health (MOH). For more information on AHRQ and how to submit a request, please visit http://www.ices.on.ca/DAS/AHRQ. This study was also supported by ICES, which is funded by an annual grant from the Ontario MOH and the Ministry of Long-Term Care (MLTC). The opinions, results and conclusions are those of the authors and are independent from the funding source. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and/or information compiled and provided by CIHI. However, the analyses, conclusions, opinions and statements expressed in the material are those of the author(s), and not necessarily those of CIHI.

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Authors and Affiliations

  1. MAP Centre for Urban Health Solutions, Toronto, ON, Canada

    Lucie Richard, Jesse I. R. Jenkinson, Katherine Francombe Pridham & Stephen W. Hwang

  2. ICES, Toronto, ON, Canada

    Haley Golding, Refik Saskin & Stephen W. Hwang

  3. ICES Western, London, ON, Canada

    Salimah Z. Shariff

  4. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Carolyn Snider & Stephen W. Hwang

  5. Unity Health Toronto, Toronto, ON, Canada

    Carolyn Snider

  6. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Andrew Boozary

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  1. Lucie Richard
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Correspondence to Lucie Richard.

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Richard, L., Golding, H., Saskin, R. et al. Trends in emergency department visits during cold weather seasons among patients experiencing homelessness in Ontario, Canada: a retrospective population-based cohort study. Can J Emerg Med 26, 339–348 (2024). https://doi.org/10.1007/s43678-024-00675-7

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  • DOI: https://doi.org/10.1007/s43678-024-00675-7

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