Differential age-associated brain atrophy and white matter changes among homeless and precariously housed individuals compared with the general population

Jacob L Stubbs; Andrea A Jones; Daniel Wolfman; Ryan C Y Chan; Fidel Vila-Rodriguez; Alexandra T Vertinsky; Manraj K Heran; Wayne Su; Donna J Lang; Thalia S Field; Kristina M Gicas; Melissa L Woodward; Allen E Thornton; Alasdair M Barr; Olga Leonova; William MacEwan; Alexander Rauscher; William G Honer; William J Panenka

doi:10.1136/bmjno-2022-000349

Differential age-associated brain atrophy and white matter changes among homeless and precariously housed individuals compared with the general population

BMJ Neurol Open. 2023 Jan 13;5(1):e000349. doi: 10.1136/bmjno-2022-000349. eCollection 2023.

Authors

Jacob L Stubbs^{1

2}, Andrea A Jones³, Daniel Wolfman^{1

2}, Ryan C Y Chan^{1

2}, Fidel Vila-Rodriguez^{1

4}, Alexandra T Vertinsky⁵, Manraj K Heran⁵, Wayne Su^{1

2}, Donna J Lang^{2

5}, Thalia S Field³, Kristina M Gicas⁶, Melissa L Woodward^{1

2}, Allen E Thornton^{2

7}, Alasdair M Barr⁸, Olga Leonova¹, William MacEwan¹, Alexander Rauscher⁹, William G Honer^{1

2}, William J Panenka^{1

2

10}

Affiliations

¹ Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada.
² British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada.
³ Division of Neurology, University of British Columbia, Vancouver, BC, Canada.
⁴ Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver, BC, Canada.
⁵ Department of Radiology, University of British Columbia, Vancouver, BC, Canada.
⁶ Department of Psychology, York University, Toronto, ON, Canada.
⁷ Department of Psychology, Simon Fraser University, Burnaby, BC, Canada.
⁸ Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada.
⁹ Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
¹⁰ British Columbia Neuropsychiatry Program, University of British Columbia, Vancouver, BC, Canada.

Abstract

Background: Homeless or precariously housed individuals live with poor health and experience premature mortality compared with the general population, yet little is known about age-related brain changes among these individuals. We evaluated whether MRI measures of brain structure are differentially associated with age and selected risk factors among individuals who are homeless or precariously housed compared with a general population sample.

Methods: We compared T1-weighted and diffusion tensor imaging measures of brain macrostructure and white matter microstructure in a well-characterised sample of 312 precariously housed participants with a publicly available dataset of 382 participants recruited from the general population. We used piecewise and multiple linear regression to examine differential associations between MRI measures and between the samples, and to explore associations with risk factors in the precariously housed sample.

Results: Compared with the general population sample, older age in the precariously housed sample was associated with more whole-brain atrophy (β=-0.20, p=0.0029), lower whole-brain fractional anisotropy (β=-0.32, p<0.0001) and higher whole-brain mean diffusivity (β=0.69, p<0.0001). Several MRI measures had non-linear associations with age, with further adverse changes after age 35-40 in the precariously housed sample. History of traumatic brain injury, stimulant dependence and heroin dependence was associated with more atrophy or alterations in white matter diffusivity in the precariously housed sample.

Conclusions: Older age is associated with adverse MRI measures of brain structure among homeless and precariously housed individuals compared with the general population. Education, improvements in care provision and policy may help to reduce the health disparities experienced by these individuals.

Keywords: ACQUIRED BRAIN INJURY; ALCOHOL-RELATED PROBLEMS; CONCUSSION; HEAD INJURY.