Vancouver's most vulnerable residents at elevated risk for brain injuries, study finds

Researchers from two prominent universities in Vancouver are hoping new research about health outcomes for the city's most vulnerable residents will result in better awareness, treatment and prevention of traumatic brain injuries.

After tracking 326 people for a year who live in the Downtown Eastside, Vancouver's poorest neighbourhood, researchers from Simon Fraser University and the University of British Columbia discovered that the precariously-housed residents were more likely to acquire a serious brain injury from a fall, assault or other factors than previously thought.

A traumatic brain injury (TBI) can range from a mild concussion to a severe head injury caused by a blow or other injury to the head or neck. TBIs can cause bruising, swelling or tearing of brain tissue and result in chronic impairment.

Brain Injury Canada says around 18,000 people in the country are hospitalized each year due to a TBI, while two per cent of the population lives with a brain injury.

'At higher risk'

In doing monthly screenings, the B.C. researchers said 175 traumatic brain injury events were reported by 100 of the 326 Downtown Eastside participants in their study.

Just over 60 per cent of participants who reported a TBI had one event, while nearly 40 per cent reported two or more injuries.

The study says, accounting for mild concussions which may not get reported, TBIs among Downtown Eastside residents might even be higher.

"We know these individuals are at higher risk for acquiring or experiencing a brain injury and we also know that they're experiencing more comorbid [more than one medical condition] factors that make them less able to recover from an injury or compensate from a brain injury that would happen in an otherwise quite healthy brain," said the study's lead author, Tiffany O'Connor who has a PhD in Psychology from Simon Fraser University.

The study, Traumatic brain injury in precariously housed persons: Incidence and risks, was recently published in The Lancet's open access public health journal.

The rates of TBI discovered by O'Connor's team builds on similar research from SFU and UBC in 2019, which showed that half of all homeless people may have experienced a TBI in their lifetime.

O'Connor says there is a lack of research on how traumatic brain injuries are contributing to the negative health outcomes for Vancouver's most vulnerable residents compared to what's known about TBIs sustained by athletes or soldiers. 

A recent study by UBC showed that people living in the Downtown Eastside lived, on average, 9½ fewer years than people living in affluent communities such as West Point Grey.

The SFU study said that falls accounted for 45 per cent of the TBIs, followed by assaults at 25 per cent. Nearly 10 per cent of the reported TBIs occurred during a drug overdose, while acute intoxication was reported in 45 per cent of injuries.

"In terms of substance dependencies, participants with opioid dependence were at higher odds for incident TBI than those without," the report said.

O'Connor hopes the research will help develop better awareness and health interventions to prevent and treat traumatic brain injuries in the future. The research showed that having one TBI increased the likelihood of having more.

"Brain injuries have consequences no matter where they occur and this just happens to be an environment where the consequences may be even more severe," said O'Connor.

She wants precariously-housed people in the DTES to know how to spot the symptoms of a TBI and when to seek out medical care. She also wants practitioners and service providers to screen more often for the injuries, including those that are mild.

'Impairments lead to poor decisions'

The British Columbia Brain Injury Association said it is also advocating for early interventions such as appropriate housing and training to service providers from the provincial Mental Health and Addictions Ministry.

"These impairments lead to poor decisions, which lead to say, not paying your rent and being evicted and forced to be homeless and vulnerable,'' said Geoff Sing.

The ministry said it has recently provided a total of 103 housing spaces in Vancouver, Surrey and Abbotsford for those with complex health and mental health challenges, some resulting from brain injury.