High rates of head injury among homeless and low-income housed men: a retrospective cohort study

Emerg Med J. 2014 Jul;31(7):571-575. doi: 10.1136/emermed-2012-201761. Epub 2013 Apr 27.

Abstract

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.

Keywords: Trauma, head; alcohol abuse; epidemiology; head.

MeSH terms

  • Adult
  • Alcoholism / epidemiology
  • Canada / epidemiology
  • Craniocerebral Trauma / epidemiology*
  • Emergency Service, Hospital
  • Humans
  • Ill-Housed Persons*
  • Interviews as Topic
  • Male
  • Middle Aged
  • Poverty*
  • Retrospective Studies
  • Risk Factors