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Association between traumatic brain injury and incarceration: a population-based cohort study

McIsaac KE, Moser A, Moineddin R, Keown LA, Wilton G, Stewart LA, Colantonio A, Nathens AB, Matheson FI. CMAJ Open. 2016; 4(4):E746-53.


Background — There is recent evidence to suggest that sustaining a traumatic brain injury (TBI) increases risk of criminal justice system involvement, including incarceration. The objective of this study was to explore the association between traumatic brain injury (TBI) and incarceration risk in men and women.

Methods — We identified a cohort of 1.418 million young adults (aged 18-28) on July 1, 1997, living in Ontario, Canada, from administrative health records; they were followed to December 31, 2011. TBI history was obtained from emergency and hospital records and incarceration history was obtained from Canadian federal correctional records. We estimated the hazard of incarceration using Cox Proportional Hazard Models, adjusting for relevant sociodemographic characteristics and medical history.

Results — There were 3531 incarcerations over 18 297 599 person-years of follow-up. The incidence of incarceration was higher in persons with prior TBI compared to those without a prior TBI. In fully adjusted models, men and women who had sustained a TBI were approximately 2.5 times more likely to be incarcerated than men and women who had not sustained a TBI, respectively.

Interpretation — TBI was associated with an increased risk of incarceration in men and women in Ontario. Our research highlights the importance of designing primary, secondary and tertiary prevention strategies to mitigate risk of TBI and incarceration in the population.

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Keywords: Trauma Neurological disorders Wounds and injuries

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