Traumatic brain injury in precariously housed persons: Incidence and risks

Tiffany A O'Connor; William J Panenka; Emily M Livingston; Jacob L Stubbs; Julia Askew; Charanveer S Sahota; Samantha J Feldman; Tari Buchanan; Linwan Xu; X Joan Hu; Donna J Lang; Melissa L Woodward; Wendy Loken Thornton; Kristina M Gicas; Alexandra T Vertinsky; Manraj K Heran; Wayne Su; G William MacEwan; Alasdair M Barr; William G Honer; Allen E Thornton

doi:10.1016/j.eclinm.2022.101277

Traumatic brain injury in precariously housed persons: Incidence and risks

EClinicalMedicine. 2022 Feb 1:44:101277. doi: 10.1016/j.eclinm.2022.101277. eCollection 2022 Feb.

Authors

Tiffany A O'Connor^{1

2}, William J Panenka^{2

3}, Emily M Livingston^{1

2}, Jacob L Stubbs^{2

3}, Julia Askew^{2

3}, Charanveer S Sahota^{1

2}, Samantha J Feldman⁴, Tari Buchanan³, Linwan Xu⁵, X Joan Hu⁵, Donna J Lang^{2

6}, Melissa L Woodward^{2

3}, Wendy Loken Thornton¹, Kristina M Gicas^{2

3

4}, Alexandra T Vertinsky⁶, Manraj K Heran⁶, Wayne Su^{2

3}, G William MacEwan³, Alasdair M Barr^{2

7}, William G Honer^{2

3}, Allen E Thornton^{1

2}

Affiliations

¹ Department of Psychology, Simon Fraser University, Burnaby, BC, Canada.
² British Columbia Mental Health and Substance Use Services Research Institute.
³ Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
⁴ Department of Psychology, York University, Toronto, ON, Canada.
⁵ Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada.
⁶ Department of Radiology, University of British Columbia, Vancouver, BC, Canada.
⁷ Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada.

Abstract

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.

Funding: Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, William and Ada Isabelle Steel Research Fund, Simon Fraser University Vice-President Research Undergraduate Student Research Award and Simon Fraser University Psychology Department Research Grant.

Keywords: Comorbidity; Concussion; Head injury; Homelessness; Marginalization; Prevalence; Risk factors.