Incidence and Associated Risk Factors of Traumatic Brain Injury in a Cohort of Homeless and Vulnerably Housed Adults in 3 Canadian Cities


To examine the factors associated with incident traumatic brain injury (TBI) among homeless and vulnerably housed persons over a 3-year follow-up period.

Setting and participants:

Data were obtained from the Health and Housing in Transition study, which tracked the health and housing status of 1190 homeless or vulnerably housed individuals in 3 Canadian cities for 3 years.

Design and Main Measures:

Main measure was self-reported incident TBI during the follow-up period. Factors associated with TBI were ascertained using mixed-effects logistic regression.


During first, second, and third years of follow-up, 187 (19.4%), 166 (17.1%), and 172 (17.9%) participants reported a minimum of 1 incident TBI, respectively. Among 825 participants with available data for all 3 years of follow-up, 307 (37.2%) reported at least 1 incident TBI during the 3-year follow-up period. Lifetime prevalence of TBI, endorsing a history of mental health diagnoses at baseline, problematic alcohol and drug use, younger age, poorer mental health, and residential instability were associated with increased risk of incident TBI during follow-up period.


Mental health support and addressing residential instability and problematic substance use may reduce further risk of TBI and its associated poor health and social outcomes in this population.

Publication Date: 
November 2016
Journal Name: 
Journal of Head Trauma Rehabilitation