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Incidence and Associated Risk Factors of Traumatic Brain Injury in a Cohort of Homeless and Vulnerably Housed Adults in 3 Canadian Cities

Nikoo, Mohammadali MD; Gadermann, Anne PhD; To, Matthew J. BMSc; Krausz, Michael MD, PhD, FRCPC; Hwang, Stephen W. MD, MPH; Palepu, Anita MD, MPH, FRCPC, MACP

The Journal of Head Trauma Rehabilitation: July/August 2017 - Volume 32 - Issue 4 - p E19–E26
doi: 10.1097/HTR.0000000000000262
Focus on Clinical Research and Practice

Objective: To examine the factors associated with incident traumatic brain injury (TBI) among homeless and vulnerably housed persons over a 3-year follow-up period.

Setting and participants: Data were obtained from the Health and Housing in Transition study, which tracked the health and housing status of 1190 homeless or vulnerably housed individuals in 3 Canadian cities for 3 years.

Design and Main Measures: Main measure was self-reported incident TBI during the follow-up period. Factors associated with TBI were ascertained using mixed-effects logistic regression.

Results: During first, second, and third years of follow-up, 187 (19.4%), 166 (17.1%), and 172 (17.9%) participants reported a minimum of 1 incident TBI, respectively. Among 825 participants with available data for all 3 years of follow-up, 307 (37.2%) reported at least 1 incident TBI during the 3-year follow-up period. Lifetime prevalence of TBI, endorsing a history of mental health diagnoses at baseline, problematic alcohol and drug use, younger age, poorer mental health, and residential instability were associated with increased risk of incident TBI during follow-up period.

Conclusion: Mental health support and addressing residential instability and problematic substance use may reduce further risk of TBI and its associated poor health and social outcomes in this population.

Institute of Mental Health, Centre for Health Evaluation and Outcome Sciences, Department of Medicine (Dr Nikoo), Centre for Health Evaluation and Outcome Sciences, Department of Medicine (Dr Gadermann), Addiction Research, Institute of Mental Health (Dr Krausz), and Division of General Internal Medicine, Centre for Health Evaluation and Outcome Sciences, Department of Medicine (Dr Palepu), University of British Columbia, Vancouver, British Columbia, Canada; and Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada (Mr To and Dr Hwang).

Corresponding Author: Mohammadali Nikoo, MD, Institute of Mental Health, Centre for Health Evaluation and Outcome Sciences, Department of Medicine, University of British Columbia, David Strangway Bldg 430-5950, University Blvd, Vancouver, BC V6T 1Z3, Canada (

Canadian Institute of Health Research (CIHR) has funded the Health and Housing in Transition study (HHiT). We thank the following individuals from our community partner organizations: Laura Cowan, Liz Evans, Stephanie Gee, Clare Hacksel, Erika Khandor, and Wendy Muckle. The authors also thank the study coordinators and interviewers in each of the 3 cities as well as the shelter, drop-in, and municipal and provincial staff for their assistance with participant recruitment and follow-up. We thank the Health and Housing in Transition study participants for their contribution to these data. We also thank Marc Vogel, Fiona Choi, and Kerry Jang and Monica Norena for their contribution to the idea formulation and discussion to develop this manuscript.

The authors declare no conflicts of interests.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.