Homeless and marginally housed people are much more likely to die and to have shorter life expectancy than even the poorest Canadians, according to a new Canadian study published today in the online version of the British Medical Journal (bmj.com).
“We already knew that there were high levels of excess mortality among the homeless compared with the general population,” says lead researcher Stephen W. Hwang, a scientist in the Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital.
“But until now little information was available on death rates among homeless and marginally housed people living in low-cost collective dwellings,” he adds.
For the purposes of the study these dwellings included: shelters and hostels for the homeless; missions; YMCA/YWCA facilities; rooming and lodging houses; and low-cost, often subsidized hotels, motels, and tourist homes. People sometimes referred to as being “marginally housed” might live in low-cost collective dwellings such as YMCA/YWCA facilities, rooming and lodging houses, and single room occupancy hotels, where each resident has a bedroom and shared access to bathroom facilities.
Using data from the 1991-2001 Canadian census, Dr. Hwang and his colleagues tracked 15,000 homeless and marginally housed men and women from all across Canada over an 11-year period. (The 1991 census made no attempt to enumerate homeless people sleeping outside, so these individuals were not included in the new study.)
”We observed that mortality rates among homeless, marginally housed people were substantially higher than rates observed even among those in the poorest income groups,” says Dr. Hwang, an associate professor in Public Health Sciences at the University of Toronto.
- Marginally housed men had just a 31 percent chance of surviving to age 75 years, compared to a 51 percent chance for poor men who did not live in these settings, the study found.
- Women living in marginal housing fared a bit better. They had a 60 percent chance of surviving until age 75, compared to a 72 percent chance for poor women who did not live in these settings.
- A 25 year-old man living marginal housing could expect to live another 42 years—a full decade less than men of the same age living in the general population. A 25 year-old woman could expect to live another 52 years—a full six years less than similarly aged women from the general population.
Many excess deaths reported in Dr. Hwang’s study were linked to alcohol and smoking-related diseases, mental disorders, suicide and violence. Some of the deaths by violence might have been related to substance abuse.
(Researchers use the term “excess deaths” to describe deaths which theoretically would not have occurred if a certain group—in this case, marginally housed people—lived under the same conditions as people in the general population.
Dr. Hwang and his colleagues found that some types of marginal housing were associated with shorter life expectancies than others. Shelters were the worst. On average, life was 13 years shorter for men and eight years shorter for women living in this type of accommodation. Living in a rooming house decreased men’s life expectancy by 11 years and women’s by nine years. Low-cost hotels were a bit better—life expectancy was cut by eight years for men living there and by five years for women.
“Our findings emphasize the importance of looking at people’s housing as a possible marker of socioeconomic disadvantage,” says Dr. Hwang.
He believes that the many of the excess deaths observed among residents of marginal housing could be prevented. “For example interventions that improve housing affordability and quality would mean that fewer people find themselves living in shelters and rooming houses. More and better programs for marginally housed people and those with addictions and mental illness could also help improve life expectancy,” he adds.
About marginal housing and who lives there
Much attention has been paid to Canadians on the extreme end of the spectrum—homeless people “sleeping rough” on the street. But many more homeless people live for many months and even years in low-cost, collective dwellings known as “marginal housing.” These include:
- shelters run by community organizations such as the YMCA/YWCA
- rooming and lodging houses
- single room occupancy hotels, where each resident has a bedroom and shared access to bathroom facilities
- motels and hotels, sometimes with rent subsidized by welfare agencies
The latest study by Dr. Hwang et al. found that men who lived in these situations tended to be middle-aged (45-64 years). Women were more likely to be older (age 65 years and more). Those living in marginal housing were much less likely to have been married, to have completed a high school education, and to have been born outside Canada.
About St. Michael’s Hospital
St. Michael’s Hospital is a large and vibrant teaching hospital in the heart of Toronto. The physicians and staff of St. Michael’s Hospital provide compassionate care to all who walk through its doors and outstanding medical education to future health-care professionals in more than 23 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care and care of the homeless and vulnerable populations in the inner city are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing Knowledge Institute, research at St. Michael’s Hospital is recognized, respected and put into practice around the world. Founded in 1892, the Hospital is fully affiliated with the University of Toronto.
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