Trends in Emergency Department Visits During Cold Weather Seasons Among Patients Experiencing Homelessness in Ontario, Canada: A Retrospective Population-Based Cohort Study

Abstract

Purpose: Anecdotal reports suggest that people experiencing homelessness visit emergency departments (EDs) to avoid cold weather exposure when they lack other shelter options. We examined monthly ED visits among people experiencing homelessness in Ontario to determine whether there has been an 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 during the 2018/2019 to 2022/2023 cold weather seasons. 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 people experiencing homelessness compared to those not experiencing homelessness. 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 people experiencing homelessness in Ontario. Non-urgent ED visits increased 24% (RR 1.24 [95% CI 1.14-1.34]) in 2022/2023 compared to previous cold weather seasons. In Toronto, such visits increased by 68% (RR 1.68 [95% CI 1.57-1.80]). Among people not experiencing homelessness, 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 is likely related to inadequate access to emergency shelter beds and warming services in the community.

Note:

Funding Information: This work was supported by the Applied Health Research Questions (AHRQ) Portfolio at ICES, which is funded by the Ontario Ministry of Health (MOH). 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).

Conflict of Interests: The study authors declare no competing interests.

Ethical Approval: The use of data in this project was authorized under section 45 of Ontario’s Personal Health Information Protection Act, which does not require review by a research ethics board.

Keywords: Homelessness, Cold-related visits, Emergency department