title: High rates of head injury among homeless and low-income housed men: a retrospective cohort study.
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.
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.|Centre for Research on Inner-City Health, St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Tomislav
authors.initials: T
authors.lastname: Svoboda
authors.affiliation: Health Studies Program, Department of Anthropology, University of Toronto Scarborough, Ontario, Canada.
authors.forename: Jason T
authors.initials: JT
authors.lastname: Ramsay
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D006259:Craniocerebral Trauma / Q000453:epidemiology*; D004636:Emergency Service, Hospital; D006703:Ill-Housed Persons; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011203:Poverty; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Trauma, head; alcohol abuse; epidemiology; head