Traumatic brain injury in precariously housed persons: Incidence and risks

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. MethodsBetween 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.

Incidence and contributing factors of dementia among people living with HIV in British Columbia, Canada, from 2002 to 2016: a retrospective cohort study

“…56 Moreover, a substantial proportion of our study population had a history of residency in the DTES, where over 50% of residents were reported to have experienced at least one TBI event per year. 57 Our results also confirm that this subgroup of PLWH is significantly more likely to have TBI and experience a more significant number of TBI episodes. Previous studies have also identified a substantially higher risk of TBI in similar marginalised settings with higher rates of homelessness, substance use and crime.…”

“…59 TBI among marginalised individuals frequently results from falls, physical assaults and hitting one's head on objects, often in the presence of substance intoxication. 57 Since TBI is associated with dementia and other adverse health outcomes, targeted interventions such as enhancement of neighbourhood safety and effective SUD treatment are required to prevent TBIs among PLWH, especially those in marginalised neighbourhoods. Moreover, understanding the clinical and epidemiological features of dementia in relation to TBI and SUD is critical in designing preventative measures to reduce the individual and societal impacts of these conditions in our population.…”

Exploring medical cannabis use in individuals with a traumatic brain injury

“…Anxiety was reported as a reason for medical cannabis use in 40 patients (75.5%). Anxiety is commonly reported as a reason for initiating medical cannabis use [44,48,73]. Mental health issues following a TBI are common [74] and medical cannabis might help to alleviate these symptoms.…”

Co-designing an Outreach Intervention for Women Experiencing Street-Involvement and Gender-Based Violence: Community–Academic Partnerships in Action

“…The interrelationships between GBV and SI contribute to catastrophic health and social inequities for women, for instance, poverty, homelessness, isolation, depression, posttraumatic stress disorder, traumatic brain injury, and premature death ( Boyd et al, 2018 ; Hayashi et al, 2016 ; O'Connor et al, 2022 ; Stubbs et al, 2022 ; Wallstam et al, 2017 ). Despite these pressing problems, women encounter considerable challenges in receiving appropriate and timely health and social care ( Bungay, 2013 ; Kneck et al, 2021 ; Maulsby et al, 2015 ).…”