"The most striking finding of this study is that men who use homeless shelters in Toronto had total mortality rates much lower than the corresponding rates reported among homeless men in Boston, New York City, and Philadelphia,"

Hey - it doesn't take a rocket scientist to figure out why the folks north of our border live longer even though they're on the street....

"Possible contributory factors include the effects of universal health insurance and access to health care in Canada, lower homicide rates, particularly among young men, and the differential health effects of short-term vs chronic homelessness."

Universal, easily accessed, free - FREE - healthcare, baby.  I'm sick to death of having to tell people they must continue to suffer because my prescription medicine fund is empty.  

I'm tired of watching people trudge all over town, humiliating themselves by begging at churches and on street corners for the antibiotics they need to control the infection in their abscessed tooth - and if they're in pain, fuggedaboutit - no one fills painkiller scripts, period.  

Homeless Men in Toronto Have Lower Mortality Rates Than Their US Counterparts

New York (MedscapeWire) Apr 26 -- Death rates among men who use homeless shelters in Toronto, while higher than Toronto's general population, are much lower than death rates for homeless men in Boston, New York City, and Philadelphia, according to an article appearing in the April 26 issue of The Journal of the American Medical Association.

Stephen W. Hwang, MD, MPH, from St. Michael's Hospital, University of Toronto, Ontario, Canada, and colleagues completed a 2.6-year follow-up study of mortality rates among 8933 men aged 18 years and older who used homeless shelters in Toronto in 1995, comparing them with the general population of Toronto and homeless men in Boston, New York City, and Philadelphia.

There were 201 deaths among men who used homeless shelters in Toronto, for a mortality rate of 876 per 100,000 person-years. The average age at death was 46 years (ranging from 20-84 years).

The researchers reported the following mortality rates for the Toronto homeless men vs rates for men of similar age in the city's general population:

* homeless men aged 18 to 24 years had 8.3 times higher risk of death

* those aged 25 to 44 years old had 3.7 times the risk of death

* those aged 45 to 64 had 2.3 times the mortality risk

"The most striking finding of this study is that men who use homeless shelters in Toronto had total mortality rates much lower than the corresponding rates reported among homeless men in Boston, New York City, and Philadelphia," the researchers explain. "This disparity is consistent across cities and age groups and is most significant in the middle age range, which includes about half of all homeless men in the United States."

For homeless men aged 35 to 54 years using shelters, their mortality rate in Toronto was 58% lower than their peers in Philadelphia. The researchers found that men aged 25 to 44 years using homeless shelters in Toronto had a 48% lower risk of death than their Boston counterparts and a 39% lower risk of death than New York City homeless men of the same age.

According to background information in the article, homeless persons have a high prevalence of physical diseases, mental illness, and substance abuse. The homeless have less than optimal access to healthcare and they are at increased risk of infections including tuberculosis and human immunodeficiency virus (HIV). In addition to disease, homeless persons are continually exposed to the elements. Even though it is known that homeless people in the United States have higher mortality rates than their counterparts in the general population, the authors comment that few comparison data exist for death rates among homeless persons in other developed countries. \

According to background information from a Boston-based study, the leading cause of death among young men was homicide, among 25- to 44-year old men it was the acquired immunodeficiency syndrome (AIDS), and among older men it was cancer and heart disease.

Results from a study in Philadelphia reported that homeless adults have an age-adjusted mortality rate 3.5 times higher than that of the general population. A New York City study of homeless shelter users found age-adjusted death rates 2 to 3 times higher than that of the city's general population. In the Boston-based study, mortality rates were 5.9, 3.0, and 1.6 times higher than in the general population among men aged 18 to 24, 25 to 44, and 45 to 64 years, respectively.

The researchers speculate on the reasons for the disparity in mortality rates between the United States and Canada: "Possible contributory factors include the effects of universal health insurance and access to health care in Canada, lower homicide rates, particularly among young men, and the differential health effects of short-term vs chronic homelessness. Insights into the reasons behind lower mortality among homeless men in Toronto could help direct efforts to reduce deaths among homeless persons and other disadvantaged populations in the United States."