Investigating the spatial association between supervised consumption services and homicide rates in Toronto, Canada, 2010–2023: an ecological analysis

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Lancet Regional Health-Americas Pub Date : 2025-02-15 DOI:10.1016/j.lana.2025.101022

Dan Werb , Hae Seung Sung , Yingbo Na , Indhu Rammohan , Jolene Eeuwes , Ashley Smoke , Akwasi Owusu-Bempah , Thomas Kerr , Mohammad Karamouzian

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Abstract

Background

Supervised consumption services (SCS) are effective at preventing overdose mortality. However, their effect on public safety remains contested. We investigated homicide rates in areas near SCS in Toronto.

Methods

We classified coroner-reported fatal shootings and stabbings (January 1st, 2010 to September 30th 2023) by geographic zone: within 500 m (‘near’), between 500 m and 3 km (‘far’), and beyond 3 km of an SCS (‘out’). We then used Poisson regression to calculate the rate ratio (RR) across zones 18, 36, 48, and 60 months pre vs. post SCS implementation. Finally, we compared spatial homicide incidence prior to and after the date of the implementation of each SCS using interrupted time series (ITS).

Findings

Overall, 956 homicides occurred, and 590 (62%) were fatal shootings and stabbings. There was no meaningful change in the rate of fatal shootings and stabbings within 3 kms of SCS (near and far zones) after their implementation. However, between 48 and 60 months pos-implementation, we detected an increase in out zones. In an ITS analysis, we observed a reduction in the monthly incidence in near zones and an increase in out zones.

Interpretation

SCS implementation was not associated with increased homicide rates; instead, we observed a reduction in monthly incidence near SCS. These results may inform drug market activity responses that optimize community health and safety.

Funding

Canadian Institutes of Health Research, the New Frontiers in Research Fund, St. Michael’s Hospital Foundation.

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2010-2023年加拿大多伦多市监督消费服务与凶杀率的空间关联研究：一个生态分析

背景：监督消费服务（SCS）在预防过量死亡方面是有效的。然而，它们对公共安全的影响仍然存在争议。我们调查了多伦多SCS附近地区的凶杀率。方法：我们根据地理区域对验尸官报告的致命枪击和刺杀事件（2010年1月1日至2023年9月30日）进行分类：500米内（“近”），500米至3公里（“远”），以及超过3公里（“外”）。然后，我们使用泊松回归计算实施SCS前后18、36、48和60个月的发病率比（RR）。最后，我们使用中断时间序列（ITS）比较了每个SCS实施日期前后的空间凶杀发生率。总体而言，发生了956起凶杀案，其中590起（62%）是致命的枪击和刺杀。在实施这些措施后，在安全区域3公里范围内（远近区域）的致命枪击和持刀伤人率没有显著变化。然而，在实施后48至60个月之间，我们发现我们的地区有所增加。在ITS分析中，我们观察到近区每月发病率减少，而外区发病率增加。scs的实施与凶杀率增加无关；相反，我们观察到SCS附近的月发病率降低。这些结果可能为药物市场活动的反应提供信息，从而优化社区健康和安全。加拿大卫生研究所、研究新前沿基金、圣迈克尔医院基金会。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Lancet Regional Health-Americas Multiple-

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8.00

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0.00%

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期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.