Research Reports - Traumatic brain injury and mortality in the homeless

J Neurotrauma. 2015 Jan 15;32(2):116-9

McMillan TM(1), Laurie M, Oddy M, Menzies M, Stewart E, Wainman-Lefley J

Risk factors for head injury are also risk factors for becoming homeless but
there is little research on this vulnerable group, who can be neglected by health
services that specialize in acquired brain injury. This study investigates the
prevalence of admissions to hospital with a head injury in the homeless and
associations with later mortality. It compares homeless people with and without a
record of hospitalized head injury (HHI) and the Glasgow population. Data were
obtained from a U.K. National Health Service strategy to enhance care of the
homeless. This included development and production of local registers of homeless
people. In Glasgow, the initiative took place over a seven-year period
(2004-2010) and comprised 40 general practitioner (family practice) services in
the locality of 55 homeless hostels. The register was linked to hospital
admissions with head injury recorded in Scottish Medical Records and to the
General Register of Scotland, which records deaths. A total of 1590 homeless
people was registered in general practitioner (family doctor) returns. The
prevalence of admission to hospital with head injury in the homeless over a
30-year period (13.5%) was 5.4 times higher than in the Glasgow population. In
the homeless with HHI, 33.6% died in the seven-year census period, compared with
13.9% in the homeless with no hospitalized HI (NHHI). The standardized mortality
ratio for HHI (4.51) was more than twice that for NHHI (2.08). The standardized
mortality ratio for HHI aged 15-34 (17.54) was particularly high. These findings
suggest that HHI is common in the homeless relative to the general population and
is a risk factor for late mortality in the homeless population.

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