Traumatic brain injury in precariously housed persons: Incidence and risks

Background Homeless and precarious housed persons are particularly prone to traumatic brain injuries (TBIs), but existent incidence rates are hampered by poor case acquisition. We rigorously documented TBIs in precariously housed persons transitioning in and out of homelessness. Methods Between December 2016 and May 2018, 326 precariously housed participants enrolled in a longitudinal study in Vancouver, Canada were assessed monthly for TBI occurrences after education on sequelae. Over one participant-year, 2433 TBI screenings were acquired for 326 person-years and variables associated with odds of incident TBI were evaluated. Findings One hundred participants acquired 175 TBIs, yielding an observed incidence proportion of 30.7% and event proportion of 53.7%. Of the injured, 61% reported one TBI and 39% reported multiple injuries. Acute intoxication was present for more than half of the TBI events assessed. Additionally, 9.7% of TBI events occurred in the context of a drug overdose. Common injury mechanisms were falls (45.1%), assaults (25.1%), and hitting one's head on an object (13.1%). In this community-based but non-randomly recruited sample, exploratory analyses identified factors associated with odds of an incident TBI over one year of follow-up, including: schizophrenia disorders (odds ratio (OR) = 0.43, 95% confidence interval (CI) 0.19, 0.94), role functioning (OR = 0.69, 95% CI 0.52, 0.91), opioid dependence (OR = 2.17, 95% CI 1.27, 3.72) and those reporting past TBIs (OR =1.99, 95% CI 1.13, 3.52). Interpretation Given the ubiquity of TBIs revealed in this precariously housed sample, we identify an underappreciated and urgent healthcare priority. Several factors modified the odds of incident TBI, which can facilitate investigations into targeted prevention efforts. Copyright (c) 2022 The Author(s). Published by Elsevier Ltd.

Automated summary

This study investigates traumatic brain injuries (TBIs) in precariously housed individuals. The results show a high incidence rate of TBIs, with some individuals experiencing multiple injuries. TBIs often occur in the context of acute intoxication and drug overdose, and common injury mechanisms include falls, assaults, and hitting one's head on an object. The study also identifies schizophrenia disorders, role functioning, opioid dependence, and past TBIs as factors associated with the odds of incident TBI.