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

BACKGROUND: Individuals 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. METHODS: We 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. RESULTS: Men 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). CONCLUSIONS: While 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.