Evidence map›Paper›PMID 42021287›Full record

ArticleBMC public health2026

Dying younger, dying of overdose: gendered and age dimensions of mortality and shelter service access among individuals experiencing homelessness in Toronto, Canada.

Farihah Ali, Jordan Mende-Gibson, Nikki Bozinoff, Pamela Leece, Zoë Dodd, Rose A Schmidt, Jürgen Rehm

Abstract read
In one paragraph

Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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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

0 citing papers in PubMed.

No citing paper in PubMed yet.

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.

Farihah AliInstitute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, ON, M5T 1R8, Canada. farihah.ontcrism@gmail.com.
Jordan Mende-GibsonInstitute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, ON, M5T 1R8, Canada.
Nikki BozinoffCampbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St, Toronto, ON, M5T 1R8, Canada.
Pamela LeeceDepartment of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th floor, Toronto, M5G1V7, Canada.
Zoë DoddMAP Centre for Urban Health Solutions, Unity Health, Toronto, ON, Canada.
Rose A SchmidtDepartment of Internal Medicine, Yale School of Medicine, 356 Cedar St, New Haven, CT, 06510, USA.
Jürgen RehmInstitute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), 250 College Street, Toronto, ON, M5T 1R8, Canada.

Funding

CIHR REN-181677
6 · The paper itself

Abstract

backgroundIndividuals experiencing homelessness in Canada face high morbidity and mortality due to intersecting toxic drug and housing crises. These risks are profoundly gendered; women experiencing homelessness have a median age of death of just 36 years, significantly lower than women in the general population (85 years), and face heightened overdose risk. Despite these inequities, gender-disaggregated analyses across homelessness, shelter systems, and mortality remain limited. This study integrates multiple publicly available datasets to examine how gender and age shape patterns of homelessness, service access, and overdose mortality in Toronto, Ontario.

methodsWe drew on publicly available datasets to examine gendered patterns of homelessness, shelter service use and operations, and mortality in Toronto. Data extracted included: demographics, shelter visits, shelter capacity, service availability, and mortality by cause and location. When possible, data were aggregated by quarter and disaggregated by age and gender. Chi-square tests were performed when possible to assess differences by gender.

resultsMen comprised most people experiencing homelessness (57%), shelter users (58%), and individuals living outdoors (68%). However, women and gender-diverse individuals accounted for a larger share of outdoor deaths occurring at younger ages (< 40 years) compared with men. Although men accounted for most deaths in shelters (78%), there was no significant gender difference in the age of in-shelter mortality (p = 0.19). Shelter capacity was structurally gender-imbalanced: there were more men-only beds (37%) than women-only beds (18%). Harm reduction availability was limited across all shelter types and was lowest in women-only shelters (26%). Overdose was leading among women (76% of all deaths) and gender-diverse individuals (80%), compared to 46% of deaths among men. In addition, overdose deaths among women and gender-diverse individuals were significantly more concentrated in younger age groups (< 40 years), compared to men (p = 0.024).

conclusionsWhile men represent the largest share of the homeless population, women and gender-diverse individuals account for a disproportionate share of overdose and premature deaths, often at younger ages. Limited women-only shelter capacity, scarcity of gender-responsive harm reduction services, and safety concerns in mixed-gender shelters may contribute to women and gender-diverse individuals relying on hidden homelessness or unsheltered settings, where harms are more likely to occur. Addressing these inequities requires expanding women-only and gender-affirming shelter spaces, strengthening trauma-informed and gender-responsive harm reduction, and ensuring staff are trained to provide safe, non-stigmatizing care.

Indexed as

Drug OverdoseIll-Housed PersonsAdolescentAdultAgedAged, 80 and overAge FactorsFemaleHumansMaleMiddle AgedOntarioSex FactorsYoung AdultGenderHarm ReductionHomelessnessMorbidityOntarioOverdoseShelter Usage

Identifiers

PMID42021287
PMCPMC13151364

What Socratic holds

Textmetadata
LicenceCC BY
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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 Socratic graph.