BMJ Open. 2026 Aug 28;16(8):e118421. doi: 10.1136/bmjopen-2026-118421.
ABSTRACT
BACKGROUND: The transition from chronic homelessness to being housed is a period of increased mortality risk. Examining the post-housing period is important for improving our understanding of this increased risk.
OBJECTIVES: To investigate, in a retrospective cohort study, the mortality rate of people who had been chronically homeless and who moved into supported housing and to identify risk factors associated with mortality.
DESIGN: Retrospective cohort study with eligible records reviewed from 1 October 2017 until 14 June 2024.
SETTING: Three supported housing units in Ottawa, Ontario, Canada.
PARTICIPANTS: Participants were any individual, alive or deceased, who moved into one of the eligible supported housing units within 6 months of their opening date. 123 participants were included in the study. The mean age was 41.3 (SD 11.9) years, and 76 (62%) were male.
OUTCOMES: The primary outcome was all-cause and cause-specific mortality following transition to supported housing. Differences in demographics and morbidity were also compared between people who were alive as of 14 June 2024 and those who were deceased as of 14 June 2024.
RESULTS: During a mean follow-up of 2.6 years, there were 27 deaths recorded (22% of those who moved into supported housing). Most, 11 (40%), died from ‘other causes’, where the cause of death was unclear or unknown and where they were found dead in their room, seven (26%) died of ‘natural causes’ usually in hospital after a medical event, seven (26%) of an opioid overdose and two (8%) where we have suppressed cause of death for privacy. There were no statistically significant differences in psychiatric diagnoses, substance use, medical diagnoses or opioid agonist therapy between those who died and those still alive at the end of the study period. Survival differed significantly across age groups (log-rank χ²=11.05, p=0.011), with residents aged 31-45 years demonstrating better survival than older age groups. No significant differences in survival were observed by sex.
CONCLUSIONS: There is a high mortality rate in people who are chronically homeless who move into supported housing. As our findings do not identify any clear baseline risk factor, it supports the idea that the transition into housing must be complemented with comprehensive health and well-being services that can meet this population’s complex needs to reduce the mortality risk.
PMID:42665348 | DOI:10.1136/bmjopen-2026-118421
