Evidence map›Paper›PMID 39313822›Full record

ArticleBMC health services research2024

Disparities in healthcare costs of people experiencing homelessness in Toronto, Canada in the post COVID-19 pandemic era: a matched cohort study.

Lucie Richard, Brooke Carter, Rosane Nisenbaum, Michael Brown, Mikaela Gabriel, Suzanne Stewart, Stephen W Hwang

Abstract read
In one paragraph

Article in BMC health services research, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Lucie RichardMAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond St, Toronto, ON, M5B 1X1, Canada. Lucie.Richard@unityhealth.to.ORCID http://orcid.org/0000-0001-6577-5067
Brooke CarterICES Western,London Health Sciences Research Institute, London, ON, Canada.
Rosane NisenbaumMAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond St, Toronto, ON, M5B 1X1, Canada.
Michael BrownDalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Mikaela GabrielMAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond St, Toronto, ON, M5B 1X1, Canada.
Suzanne StewartDalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Stephen W HwangMAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond St, Toronto, ON, M5B 1X1, Canada.

Funding

CIHR FDN VR5-173211
6 · The paper itself

Abstract

backgroundEvidence is limited about healthcare cost disparities associated with homelessness, particularly in recent years after major policy and resource changes affecting people experiencing homelessness occurred after the onset of the COVID-19 pandemic. We estimated 1-year healthcare expenditures, overall and by type of service, among a representative sample of people experiencing homelessness in Toronto, Canada, in 2021 and 2022, and compared these to costs among matched housed and low-income housed individuals.

methodsData from individuals experiencing homelessness participating in the Ku-gaa-gii pimitizi-win cohort study were linked with Ontario health administrative databases. Participants (n = 640) were matched 1:5 by age, sex-assigned-at-birth and index month to presumed housed individuals (n = 3,200) and to low-income presumed housed individuals (n = 3,200). Groups were followed over 1 year to ascertain healthcare expenditures, overall and by healthcare type. Generalized linear models were used to assess unadjusted and adjusted mean cost ratios between groups.

resultsAverage 1-year costs were $12,209 (95% CI $9,762-$14,656) among participants experiencing homelessness compared to $1,769 ($1,453-$2,085) and $1,912 ($1,510-$2,314) among housed and low-income housed individuals. Participants experiencing homelessness had nearly seven times (6.90 [95% confidence interval [CI] 5.98-7.97]) the unadjusted mean ratio (MR) of costs as compared to housed persons. After adjustment for number of comorbidities and history of healthcare for mental health and substance use disorders, participants experiencing homelessness had nearly six times (adjusted MR 5.79 [95% CI 4.13-8.12]) the expected healthcare costs of housed individuals. The two housed groups had similar costs.

conclusionsHomelessness is associated with substantial excess healthcare costs. Programs to quickly resolve and prevent cases of homelessness are likely to better meet the health and healthcare needs of this population while being a more efficient use of public resources.

Indexed as

COVID-19Health Care CostsIll-Housed PersonsAdultCohort StudiesFemaleHealthcare DisparitiesHealth ExpendituresHumansMaleMiddle AgedOntarioPandemicsSARS-CoV-2Administrative dataDisparitiesHealthcare costsHomelessness

Identifiers

PMID39313822
PMCPMC11421185

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.