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Review explores why homeless populations in Canada and globally have “much higher” rates of cardiovascular disease-related deaths

Toronto, May 30, 2018

By Michael Oliveira

Dr. Stephen Hwang
Dr. Stephen Hwang

High rates of cardiovascular disease-related deaths among homeless people are a problem around the world, even in countries like Canada that have a universal health-care system, says Dr. Stephen Hwang, director of St. Michael’s Hospital’s Centre for Urban Health Solutions.

A review of studies focusing on the issue, published Monday in the Journal of the American College of Cardiology, finds high rates of cigarette smoking, poor control of cardiovascular disease risk factors such as hypertension and diabetes, and psychosocial issues like chronic stress, depression, heavy drinking and cocaine use have been linked to increased cardiovascular disease in homeless populations.

The countries previously studied included Canada, the United States, Finland, Scotland and Sweden.

Homeless patients may also feel unwelcome in traditional health-care settings, which can contribute to poor preventative care and management of issues.

“What we found across all countries studied was a high fatality rate from cardiovascular disease - in every country it is much higher than in the general population - while what varied was the capability of the health-care system to meet their needs and ensure they get the care they need,” said Dr. Hwang, the review’s lead author.

“Just because a person has health insurance doesn’t mean they have access to the care they need. We know people who are homeless and poor and racialized are often stigmatized and treated poorly when they’re seeking health care.”

A Canadian study focusing on more than 15,000 homeless and marginally housed adults in the years between 1991 and 2001 found deaths caused by cardiovascular disease were 61 to 71 per cent higher than in the general population.

“I think those figures would be similar today. There’s no reason to think we’ve substantially changed the situation,” said Hwang.

“I’m hoping this review will increase cardiologists’ awareness and concern for the issue so people who are homeless and marginally housed get better care.”


This paper is an example of how St. Michael's Hospital is making Ontario Healthier, Wealthier, Smarter.

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 29 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.


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