Healthcare Utilization, Legal Incidents, and Victimization Following Traumatic Brain Injury in Homeless and Vulnerably Housed Individuals: A Prospective Cohort Study
Open accessAbstract
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.
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TBI is associated with more chronic health conditions in one study.
“more chronic health conditions in one study 58”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [58]
TBI is associated with poorer self-reported physical health in three studies.
“Associated with poorer self-reported physical health in three studies 39,53,58”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [58]
TBI is associated with drug misuse in four studies.
“Associated with drug misuse in four studies 39,43,58,60”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [58]
TBI is associated with poorer self-reported mental health in three studies.
“Associated with poorer self-reported mental health in three studies 39,53,58”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [58]
TBI is associated with alcohol misuse in five studies.
“Associated with alcohol misuse in five studies, 39,43,53,58,60”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [58]
TBI is associated with a higher number of psychiatric diagnoses in three studies.
“Associated with a higher number of psychiatric diagnoses in three studies 31,43,58”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [58]
TBI is associated with having access to a physician in two studies.
“Associated with having access to a physician in two studies 58,60”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [58]
TBI is associated with employment and a higher monthly income in one study.
“Associated with employment and a higher monthly income in one study 58”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [58]
TBI is associated with higher frequency of emergency room visits and hospital admissions in three studies.
“Associated with higher frequency of emergency room visits and hospital admissions in three studies 43,58,60”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [58]
TBI is associated with a higher number of homeless episodes or a longer lifetime duration of homelessness in two studies.
“Associated with a higher number of homeless episodes or a longer lifetime duration of homelessness in two studies, 43,58”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [58]
TBI is associated with being a victim of physical or sexual assault in two studies.
“Associated with being a victim of physical or sexual assault in two studies 43,58”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [58]
TBI is associated with arrest, incarcerations, or criminal justice system involvement in five studies.
“Associated with arrest, incarcerations, or criminal justice system involvement in five studies 43,53,58-60”
From Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis (2020) · cites this paper as [58]
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- Authors
- To, M. J., O'Brien, K., Palepu, A., Hubley, A. M., Farrell, S., Aubry, T., Gogosis, E., Muckle, W., & Hwang, S. W.
- Affiliations
- St. Michael's Hospital (CA)
- Venue
- Journal of Head Trauma Rehabilitation
- Published
- 2015-07
- Volume
- 30
- Issue
- 4
- Pages
- 270-276
- ISSN
- 0885-9701 (ISSN-L)
- OpenAlex
- W2086431035
- Cited by
- 42
- References
- 24
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 1 · 2023: 5 · 2022: 8 · 2021: 8 · 2020: 1 · 2019: 2 · 2018: 3 · 2017: 3 · 2016: 2
- FWCI
- 3.01
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Journal of Head Trauma Rehabilitation (publishedVersion)
- PubMed (publishedVersion)
- TSpace (University of Toronto) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Keywords
- traumatic brain injury, homelessness, vulnerable housing, health care utilization, emergency department utilization, criminal justice involvement, incarceration, arrests, health status
- MeSH terms
- Adult, Brain Injuries, Canada, Emergency Service, Hospital, Female, Ill-Housed Persons, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Cohort Studies, Crime Victims, Vulnerable Populations
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