Shocking statistics from Canadian researchers indicate that chronically homeless men who drink heavily have 400 times the number of head injuries as the general population.

What's more, the rate of traumatic brain injuries with internal bleeding is 300 times higher than among average Canadian men, and the rate of severe head injuries is 170 times as high.

In a study published in the Emergency Medicine Journal, researchers led by Dr. Tomislav Svoboda, of St. Michael's Hospital in Toronto, detail findings about head injuries in the general homeless population and among those who live in low-income housing.

"We were shocked by the number if [sic] head injuries," said Dr. Tomislav in a news release. "In medicine, we worry when something occurs two or three times more often in a particular patient group, but to talk about magnitudes of 300 or 400 is unheard of."

Analyzing Head Injury Rates Among Homeless Men

While previous research on head injuries among homeless people was based on interviews, Svoboda says this study is the first that is actually based on emergency department records, as well as the first to compare those patterns with data on the general population of securely housed people.

The researchers conducted a retrospective review of almost six years' worth of emergency department interview records from seven inner city Toronto hospitals, recruiting 170 men who agreed to have their records released.

The participants were split into three groups: those who were chronically homeless with drinking problems, those who were homeless but without drinking problems, and those in low-income housing.

They were all assessed for any instances of head injuries, from mild concussions to severe brain trauma.

The results showed that both the general homeless population and those living in low-income housing had about 23 times as many head injuries as securely housed people. Chronically drinking homeless people, in turn, had 17 times as many as than those groups-almost 400 times as many as the general population.

In addition, the more injuries homeless men with drinking problems had, the less time passed between their head injuries. The average amount of time between head injuries was 7.7 months, and that number decreased by about 12 days with each one.

The main predictors of having a head injury were previous head injuries, seizure disorders, or drug dependence.

Healthcare for Homeless People?

In the general Canadian population in Canada, about 12 in every 10,000 men might suffer a brain injury each year. Among chronically homeless people, that number shoots up to 4,800- almost half.

In a representative sample of homeless people last year, 53 percent had traumatic brain injuries in their lifetime.

It's unclear how prevalent head injuries are among homeless people in the United States, since previous studies had fairly small, non-representative sample sizes. In American samples with 60 or more members, however, anywhere from 20 to 47 percent of those surveyed had traumatic brain injuries.

Even with the most conservative estimates, this is likely to be a significant public health issue. According to estimates from the 2011 Annual Homeless Assessment Report to Congress from the United States Department of Housing and Urban Development, about 100,000 Americans were chronically homeless that year.

Homeless people are particularly vulnerable to head injuries, said Svoboda. Such injuries cause symptoms like dizziness, memory loss, impaired thinking, and mental illness, which lead to even more head injuries. In addition, homeless people are at higher risk of being assaulted.

"We need to do something for this group-we're seeing data that suggests they are in a downward spiral," said Dr. Svoboda.

He suggested that healthcare programs could help treat the persistence of head injuries, perhaps by performing CT scans on homeless people who might be at risk.

"When the brain is injured, you can't fix it," he added. "We need to identify and support these people."


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.