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The health of homeless immigrants
  1. S Chiu1,
  2. D A Redelmeier2,3,
  3. G Tolomiczenko4,5,
  4. A Kiss6,
  5. S W Hwang1,2
  1. 1
    Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada
  2. 2
    Division of General Internal Medicine, Department of Medicine, University of Toronto, Canada
  3. 3
    Sunnybrook Health Sciences Centre, Institute for Clinical Evaluative Sciences, Toronto, Canada
  4. 4
    Crohn’s and Colitis Foundation of Canada, Toronto, Canada
  5. 5
    Department of Psychiatry, University of Toronto, Canada
  6. 6
    Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Institute for Clinical Evaluative Sciences, Toronto, Canada
  1. Correspondence to Dr S W Hwang, Centre for Research on Inner City Health, St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada; hwangs{at}


Background: This study examined the association between immigrant status and current health in a representative sample of 1189 homeless people in Toronto, Canada.

Methods: Multivariate regression analyses were performed to examine the relationship between immigrant status and current health status (assessed using the SF-12) among homeless recent immigrants (⩽10 years since immigration), non-recent immigrants (>10 years since immigration) and Canadian-born individuals recruited at shelters and meal programmes (response rate 73%).

Results: After adjusting for demographic characteristics and lifetime duration of homelessness, recent immigrants were significantly less likely to have chronic conditions (RR 0.7, 95% CI 0.5 to 0.9), mental health problems (OR 0.4, 95% CI 0.2 to 0.7), alcohol problems (OR 0.2, 95% CI 0.1 to 0.5) and drug problems (OR 0.2, 95% CI 0.1 to 0.4) than non-recent immigrants and Canadian-born individuals. Recent immigrants were also more likely to have better mental health status (+3.4 points, SE ±1.6) and physical health status (+2.2 points, SE ±1.3) on scales with a mean of 50 and a SD of 10 in the general population.

Conclusion: Homeless recent immigrants are a distinct group who are generally healthier and may have very different service needs from other homeless people.

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  • Additional full multivariate models are published online only at

  • Funding This project was supported by operating grants from the Agency for Healthcare Research and Quality (1 R01 HS014129-01) and the Canadian Institutes of Health Research (MOP-62736), and by an Interdisciplinary Capacity Enhancement grant on Homelessness, Housing, and Health from the Canadian Institutes of Health Research (HOA-80066).

  • Competing interests None.

  • Ethics approval Ethics approval was received from St. Michael’s Hospital Research Ethics Board, Toronto, Canada.

  • Contributors SC, DAR, GT, AK and SWH contributed to the study concept and design. SWH originated and supervised the overall study. SC oversaw all aspects of the data collection. SC, AK and SWH analysed and interpreted the data. SC and SWH drafted and revised the manuscript critically for important intellectual content. DAR, GT and AK critically revised the manuscript for important intellectual content. SWH is the guarantor of the paper and accepts full responsibility for the work and the conduct of the study, had access to the data and controlled the decision to publish. All authors approved the final version of the manuscript to be published.

  • Provenance and peer review Not commissioned; externally peer reviewed.