A Canadian research team from St. Michael’s Hospital in Toronto led by Dr. Tomislav Svoboda found that homeless men who drink heavily face a 400% greater chance of brain injury than the general population and a likelihood of experiencing a severe brain injury to be 170% greater than the generally recognized occurrence rate. Dr. Svoboda’s study is based on Emergency Room admissions over a 6 year retrospective period from seven inner city Toronto hospitals. The study revealed that the general homeless population and individuals live in low income housing have 23 times the brain injuries of “securely housed” people. The homeless with chronic drinking problems had 17 times as many than those group which equated to about 400 times as many brain injuries as the general population. Multiple brain injuries also was identified as a factor with the average time between injuries of 7.7 months and a decrease of 12 days each time the person was re-injured.
So, how does that stack up against the Canadian data of 12 injuries per 10,000 men per year. Among the chronically homeless the number was 4,800 per 10,000 men. In the homeless sample used in the study an astonishing 53% had brain injuries. In a discussion I had several years ago with a representative of a U.S.-based healthcare coalition for the homeless when I was researching long-term health issues, the number of brain injuries in the homeless population was estimated to be close to 80%. The person I spoke with identified the high number of brain injuries as related to the high numbers of homeless who live outside of cities and remain hidden.
The homeless represent a highly vulnerable population, especially heightened by substance abuse problems. The rate of assaults experienced by the homeless further increases their risks for brain injuries. And, once a person has a brain injury the risk for subsequent injuries skyrockets. In public health medicine, an increase in incidence of 2-3 times prompts concern and scrutiny. In the study of the homeless with TBI the rate is a shocking 400 times greater. We have a highly vulnerable population with a high risk of multiple brain injuries and a low likelihood of effective long term programs to safeguard their health.
Reference: Svoboda T, Ramsay JT. High rates of head injury among homeless and low-income housed men: a retrospective cohort study. Emergency Medicine Journal. April 27, 2013.