Data on people experiencing homelessness often come from time- and labour-intensive cross-sectional counts and surveys from selected samples. This study uses comprehensive administrative health data from emergency department (ED) visits to enumerate people experiencing homelessness and characterize demographic and geographic trends in the province of Ontario, Canada, from 2010 to 2017.

Data and methods

People experiencing homelessness were identified by their postal code, designated as “XX.” Outcomes included the number of people experiencing homelessness stratified by year and week, gender and age plotted annually, the location of each ED visit, and composition changes in demographics and geographic distribution.


Over seven years, 39,408 individuals were identified as experiencing homelessness. The number of ED visits increased over the study period in all of Ontario. The average peak in the number of visits occurred annually in September, with the fewest visits in January. Rises in overall homelessness were secondary to increases in working-age homelessness. ED presentations were concentrated in urban centres. The total proportion of patients experiencing homelessness became less concentrated in Toronto, decreasing from 60% to 40% over the study period, with a shift toward EDs outside the city.


This study shows that administrative health data can provide comprehensive information on demographics and other characteristics analyzed over time. Surveillance can be conducted cost-effectively, and changes can be tracked in real time to allow for services to be coordinated and implemented in a time-sensitive manner.


Homelessness, demography, administrative data, emergency department

DOI: https://www.doi.org/10.25318/82-003-x202100100002-eng


Homelessness is a widespread social concern in Canada and many other developed countries. More than 235,000 people in Canada experience homelessness in any given year, and 25,000 to 35,000 people may be experiencing homelessness on any given night. Homelessness can encompass a range of circumstances, including living on the streets or in places not meant for habitation; staying in overnight or emergency shelters; living temporarily as a “hidden” homeless person with friends, family or strangers, or in motels, hostels or rooming houses; and residing in precarious or inadequate housing. Understanding the composition of this population, whether homelessness is increasing, and where homelessness is a problem is important for planning and policy. However, there are numerous challenges in performing a census of people experiencing homelessness, and these can generate doubts about the quality of actionable information. [Full article]


Stephenson Strobel (sbs296@cornell.edu) is with the Department of Policy Analysis and Management, Cornell University, Ithaca, New York, United States, and the Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. Ivana Burcul, Jia Hong Dai and Zechen Ma are with the Michael G. DeGroote School of Medicine, McMaster University, Niagara Regional Campus, St. Catharines, Ontario, Canada. Shaila Jamani is with the Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada. Rahat Hossain is with the Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada


What is already known on this subject?

  • Enumeration of people experiencing homelessness varies methodologically, with the use of survey studies, Point-in-Time Counts and—very recently—the novel use of administrative health data.
  • Current “gold standard” surveillance methods introduce the risk of biased estimates from convenience sampling and have limitations such as surveying only specific communities or surveying people only on specific dates.
  • Accurate estimates of the number of people experiencing homelessness and their demographic and geographic characteristics are not currently available for planning and policy purposes in Ontario, Canada.

What does this study add?

  • An analysis of province-wide administrative health data from emergency department visits produces an estimate of 39,408 people experiencing homelessness from 2010 to 2017 in Ontario.
  • The number of people experiencing homelessness who visited emergency departments increased significantly from 2014 to 2017, with the maximum number of individuals presenting in September each year.
  • People younger than 40 have become the predominant demographic among those experiencing homelessness. The proportion of this population in Toronto, Ontario, has also decreased from 60% to 40% and moved toward Local Health Integration Networks in other areas of the province.

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