High rates of head injury among homeless and low-income housed men: a retrospective cohort study
- 1Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- 2Centre for Research on Inner-City Health, St Michael's Hospital, Toronto, Ontario, Canada
- 3Health Studies Program, Department of Anthropology, University of Toronto Scarborough, Ontario, Canada
- Correspondence to Dr Tomislav Svoboda, St Michael's Hospital, Centre for Research on Inner-City Health, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8;
- Received 12 August 2012
- Revised 28 March 2013
- Accepted 1 April 2013
- Published Online First 27 April 2013
Objective To examine the predictors and temporal patterns of head injury (HI) presentation in the emergency department among cohorts of homeless and low-income housed men.
Methods Retrospective review and logistic regression of HIs found in emergency department records for three groups of men, those: (1) who were chronically homeless with drinking problems (CHDP) (n=50), (2) in the general homeless population (GH) (n=60) and (3) in low-income housing (LIH) (n=59).
Results The proportion of individuals with non-minimal HIs documented in the previous year were 28%, 3% and 5% with annual rates of 0.47, 0.017 and 0.037 among the CHDP, GH and LIH groups (p<0.0001). In the multivariate model, independent associations with having an HI included: an HI in the previous year (OR 11.8, 95% CI 3.83 to 36.4), drug dependence (OR 3.67, 95% CI 1.11 to 12.13) and seizures (OR 3.50, 95% CI 1.13 to 10.90), while mood-disorders were protective. Homelessness had a crude risk increase of HI (OR 3.15, 95% CI 1.21 to 8.23) but was not significant in the multivariate model. Among those with HIs, chronic homelessness with drinking problems was associated with a higher rate of HI. With each successive HI, the time interval to another HI was 12 days shorter (p=0.0004). The chronic subdural haematoma incidence in the under-65-year-old CHDP group was 11 per 1000 (95% CI 2.8 to 45).
Conclusions Having an HI is better predicted by previous head injuries, drug dependence or a seizure disorder than a history of homelessness or alcohol dependence. HIs may become more frequent with time.