Health Determinants among North Americans Experiencing Homelessness and Traumatic Brain Injury: A Scoping Review

Kaitlin J Zeiler; Alwyn Gomez; Francois Mathieu; Frederick A Zeiler

doi:10.1089/neur.2021.0010

Health Determinants among North Americans Experiencing Homelessness and Traumatic Brain Injury: A Scoping Review

Neurotrauma Rep. 2021 Aug 16;2(1):303-321. doi: 10.1089/neur.2021.0010. eCollection 2021.

Authors

Kaitlin J Zeiler¹, Alwyn Gomez^{2

3}, Francois Mathieu⁴, Frederick A Zeiler^{2

3

5

6

7}

Affiliations

¹ Undergraduate Psychology Program, Faculty of Arts, University of Manitoba, Winnipeg, Manitoba, Canada.
² Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
³ Department of Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
⁴ Section of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
⁵ Biomedical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, Manitoba, Canada.
⁶ Division of Anesthesia, Department of Medicine, University of Cambridge, Cambridge, UK.
⁷ Centre on Aging, University of Manitoba, Winnipeg, Manitoba, Canada.

Abstract

Traumatic brain injury (TBI) in those experiencing homelessness has been described in recent literature as a contributor to increased morbidity, decreased functional independence, and early mortality. In this systematically conducted scoping review, we aimed to better delineate the health determinants-as defined by Health Canada/Centers for Disease Control and Prevention (CDC)-associated with TBI in North Americans experiencing homelessness. BIOSIS, MEDLINE, CINAHL, EMBASE, SCOPUS, and Global Health were searched from inception to December 30, 2020. Gray literature search consisted of relevant meeting proceedings. A two-step process was undertaken, assessing title/abstract and full articles, respectively, based on inclusion/exclusion criteria, leading to the final 20 articles included in the review. Data were abstracted, assessing the aims, literature quality, and bias. Five health determinants displayed strong associations with TBI in those North Americans experiencing homelessness, including male gender, poor physical environment, negative personal health behaviors, adverse childhood experiences (ACEs), and low educational attainment. In those studies displaying a comparator population experiencing homelessness without TBI, the TBI group displayed trends toward increased disparity in Health Canada and CDC defined health determinants. Most studies suffered from moderate limitations. There are associations between male gender, poor physical environment, negative personal health behaviors, ACEs, and limited education in those experiencing homelessness and TBI. The results suggest that those experiencing homelessness with TBI in North America suffer poorer health consequences than those without TBI. Future research on TBI in North Americans experiencing homelessness should focus on health determinants as potential areas for intervention, which may lead to improved outcomes for those experiencing both homelessness and TBI.

Keywords: North America; determinants of health; homeless; traumatic brain injury.

Publication types

Review