Online Program

Emergency Department Visits for Cold-related Injuries among Homeless Adults: A 5-Year Cohort Study in Toronto, Canada

Monday, November 2, 2015

Paige Zhang, B.Sc., Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, ON, Canada
Stephanie Gower, PhD, Healthy Public Policy, Toronto Public Health, Toronto, ON, Canada
Kate Bassil, Ph.D., Healthy Public Policy, Toronto Public Health, Toronto, ON, Canada
Alex Kiss, Ph.D., Department of Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, ON, Canada
Marko Katic, BA, Department of Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, ON, Canada
Stephen Hwang, MD, MPH, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St Michael’s Hospital, Toronto, ON, Canada
Objectives: Homeless people are believed to have an increased risk of cold-related injuries compared to the general population. This study was conducted to inform cold-weather planning from a health and shelter services perspective. We determined the rate of emergency department (ED) visits for cold-related injuries in a cohort of homeless adults and low-income controls living in a city with an average low temperature of -7 degrees C (20 degrees F) during winter months.

Methods: Homeless men and women in Toronto, Canada, were recruited in the community, and their health care utilization was ascertained over a 5-year follow-up period (2005-9) using comprehensive administrative databases. An age- and sex-matched control group of persons living in low income neighborhoods of Toronto was selected. ED visits were identified if the diagnosis was an ICD-10 code associated with cold exposure (hypothermia, frostbite, or other effects of cold). ED visit rates were compared using Poisson means.

Results: There were a total of 16 ED visits for cold-related injuries during 2,228 person-years of observation among 587 homeless men and 1,129 person-years of observation among 296 homeless women. The rate of ED visits was 6.7 per 1000 person-years of observation (95% CI, 4.2-12.4) among homeless men and 0.9 (95% CI, 0.03-5.6) among homeless women. The rates among men and women in the low-income control groups were zero.  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=0.026).

Conclusions: In Toronto, the absolute rate of ED visits for cold-related injuries among homeless persons was low. Homeless men appear to have the greatest risk of cold-related injuries.

Learning Areas:

Provision of health care to the public
Public health or related laws, regulations, standards, or guidelines
Public health or related research

Learning Objectives:
Identify health services research methods to determine rates of cold-related injury in vulnerable populations Determine incidence rates for cold-related injury in homeless men, homeless women, and low-income matched controls Discuss how health services research can inform public health planning to reduce the risk of cold-related injury among homeless persons

Keyword(s): Homelessness, Policy/Policy Development

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the medical student conducting this project as part of a research course on Determinants of Community Health. As such, I contributed to the the research, design, and analysis of this project. My primary professional interests involve inner city health and advocacy for vulnerable populations.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.