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Healthcare Utilization, Legal Incidents, and Victimization Following Traumatic Brain Injury in Homeless and Vulnerably Housed Individuals: A Prospective Cohort Study

To, Matthew J. BMSc; O'Brien, Kristen MSc; Palepu, Anita MD; Hubley, Anita M. PhD; Farrell, Susan PhD; Aubry, Tim PhD; Gogosis, Evie MSW; Muckle, Wendy MHA; Hwang, Stephen W. MD

Section Editor(s): Bushnik, Tamara PhD, FACRM; Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP; Brenner, Lisa PhD, ABPP

Journal of Head Trauma Rehabilitation: July/August 2015 - Volume 30 - Issue 4 - p 270–276
doi: 10.1097/HTR.0000000000000044
Focus on Clinical Research and Practice, Part 3

Objective: To characterize the associations between a history of traumatic brain injury (TBI) and subsequent healthcare utilization, legal involvement, and victimization.

Setting: Three major Canadian cities.

Participants: A total of 1181 homeless and vulnerably housed adults who were single and 18 years or older. Data for 968 participants (82%) were available at 1-year follow-up.

Design: Prospective cohort study. Data were collected using structured, in-person interviews at baseline in 2009 and approximately 1 year after baseline.

Main Measures: Self-reported TBI, 12-item Short Form Health Survey, healthcare, and criminal justice use questionnaires.

Results: The lifetime prevalence of TBI was 61%. A history of TBI was independently associated with emergency department (ED) use [adjusted odds ratio (AOR) = 1.5, 95% confidence interval (CI): 1.11–1.96], being arrested or incarcerated (AOR = 1.79, 95% CI: 1.3–2.48) and being a victim of physical assault (AOR = 2.81, 95% CI: 1.96–4.03) during the 1-year follow-up period.

Conclusions: Homeless and vulnerably housed individuals with a lifetime history of TBI are more likely to be ED users, arrested or incarcerated, and victims of physical assault over a 1-year follow-up period even after adjustment for health status and other confounders. These findings have public health and criminal justice implications and highlight the need for effective screening, treatment, and rehabilitation for TBI in this population.

Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario (Mr To and Mss O'Brien and Gogosis, and Dr Hwang); Centre for Health Evaluation and Outcome Sciences, Division of General Internal Medicine (Dr Palepu) and Measurement, Evaluation, and Research Methodology, Department of Educational & Counselling Psychology, and Special Education (Dr Hubley), University of British Columbia, Vancouver, British Columbia; Royal Ottawa Health Care Group (Dr Farrell), School of Psychology and Centre for Research on Educational and Community Services (Dr Aubry), and Ottawa Inner City Health Initiative (Ms Muckle), University of Ottawa, Ottawa, Ontario; and Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario (Dr Hwang).

Corresponding Author: Stephen W. Hwang, Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael's Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada (

The authors declare no conflicts of interest.

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