عنوان انگلیسی مقاله:
Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis
ترجمه فارسی عنوان مقاله:
آسیب مغزی پس از سانحه در افراد بی خانمان و حاشیه نشین: یک بررسی سیستماتیک و فراتحلیل
Sciencedirect - Elsevier - The Lancet Public Health, 5 (2020) e19-e32. doi:10.1016/S2468-2667(19)30188-4
Jacob L Stubbs, Allen E Thornton, Jessica M Sevick, Noah D Silverberg, Alasdair M Barr, William G Honer, William J Panenka
Background Homelessness is a global public health concern, and traumatic brain injury (TBI) could represent an
underappreciated factor in the health trajectories of homeless and marginally housed individuals. We aimed to
evaluate the lifetime prevalence of TBI in this population, and to summarise findings on TBI incidence and the
association between TBI and health-related or functioning-related outcomes.
Methods For this systematic review and meta-analysis, we searched without date restrictions for original research
studies in English that reported data on the prevalence or incidence of TBI, or the association between TBI and one
or more health-related or function-related outcome measures. Studies were included if they had a group or clearly
identifiable subgroup of individuals who were homeless, marginally housed, or seeking services for homeless people.
With use of random-effects models, we calculated pooled estimates of the lifetime prevalence of any severity of TBI
and the lifetime prevalence of moderate or severe TBI. We used meta-regression and subgroup analysis to evaluate
potential moderators of prevalence estimates and the leave-one-out method for sensitivity analyses. We then
summarised findings from all studies that evaluated TBI incidence and the association between TBI and healthrelated
or functioning-related outcomes. All statistical analyses were done using R version 3.5.1. The study is
registered with PROSPERO, number CRD42019119678.
Findings Of 463 potentially eligible studies identified by the search, 38 studies were included in the systematic review
and 22 studies were included in the meta-analysis. The lifetime prevalence of any severity of TBI in homeless and
marginally housed individuals (18 studies, n=9702 individuals) was 53·1% (95% CI 46·4–59·7; I²=97%) and the
lifetime prevalence of moderate or severe TBI (nine studies, n=5787) was 22·5% (13·5–35·0; I²=99%). The method
used to ascertain TBI history, the age of the sample, and the sample size significantly moderated estimated lifetime
prevalence of any severity of TBI. TBI was consistently associated with poorer self-reported physical and mental
health, higher suicidality and suicide risk, memory concerns, and increased health service use and criminal justice
Interpretation The lifetime prevalence of TBI is high among homeless and marginally housed individuals, and a
history of TBI is associated with poorer health and general functioning. Health-care providers and public health
officials should have an increased awareness of the burden of TBI in this population. Prospective and longitudinal
studies are needed to better understand how the health of this population is affected by TBI.