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

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

Publication date: Sep 24, 2024

Evidence 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. Data 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. Average 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. Homelessness 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.

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Concepts Keywords
Canada Administrative data
Healthcare Adult
Homelessness Cohort Studies
COVID-19
Disparities
Female
Health Care Costs
Health Expenditures
Healthcare costs
Healthcare Disparities
Homelessness
Humans
Ill-Housed Persons
Male
Middle Aged
Ontario
Pandemics
SARS-CoV-2

Semantics

Type Source Name
disease MESH COVID-19 pandemic
disease IDO history
disease MESH substance use disorders
drug DRUGBANK Tropicamide
pathway REACTOME Reproduction
disease MESH housing instability
disease MESH infection
disease MESH privacy
disease MESH Asthma
pathway KEGG Asthma
disease MESH Congestive Heart Failure
drug DRUGBANK Ranitidine
disease MESH death
disease MESH comorbidity
disease MESH emergency
disease IDO algorithm
drug DRUGBANK Serine
disease MESH lung disease
disease MESH heart disease
disease MESH stroke
disease MESH chronic kidney disease
disease MESH liver disease
disease MESH AIDS
disease MESH psychotic disorders
disease MESH anxiety
disease MESH obsessive compulsive disorder
disease MESH personality disorders
disease MESH neurological disorder
drug DRUGBANK Coenzyme M
disease MESH Hypertension

Original Article

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