Abstract Title Unemployment in Trauma Patients with Substance Use Disorder

Background People with substance use disorders (SUD) experience disproportionately high rates of unemployment. Challenges in attaining and maintaining employment are exacerbated in trauma patients with SUD. Employment has been associated with positive outcomes for individuals with SUD, though the effect of employment on health service utilization is unknown. This study aimed to explore the relationship between employment, emergency department (ED) utilization, and hospital readmission in trauma patients with SUD.

Methods This was a retrospective cohort study of adult (age≥ 18) trauma patients with SUD at a University Level 1 trauma center from January 2021 to December 2022 (n=692). Data was collected through chart review in REDCap. Univariate analyses were calculated using Chi-square, two-tailed t, and Wilcoxon rank sum tests. Multivariable logistic regressions were used to evaluate the primary outcomes: ED utilization (≥1 visit), frequent ED utilization (≥3 visits), and hospital readmission within one year of index encounter. A p-value of ≤0.05 was considered significant.

Results Unemployed patients (UP) were more often female, older, unhoused, and admitted with a lower injury severity score than employed patients. UP were more likely to experience multiple SUDs and a co-occurring mental health disorder. On multivariable regression, employment status was not an independent predictor of ED utilization (OR 0.943 (0.632, 1.40), p=0.770), frequent ED utilization (OR 1.22 (0.776, 1.91), p=0.392), or hospital readmission (OR 1.31 (0.881, 1.95), p=0.181) within one year. However, having a co-occurring mental health diagnosis and experiencing homelessness were independent positive predictors of ED utilization (OR 2.76 (1.86, 4.15), p<0.001; OR 3.15 (1.94, 5.22), p<0.001), frequent ED utilization (OR 2.88 (1.93, 4.31), p<0.001; OR 3.96 (2.52, 6.28), p<0.001), and hospital readmission (OR 2.09 (1.44, 3.04), p<0.001; OR 1.76 (1.14, 2.72), p=0.011).

Conclusion While we did not find an independent association between employment and health care utilization, we identified that risk factors for ED and hospital readmission like housing status and mental health history were more common amongst UP, affirming that employment, housing, and mental health are deeply interconnected in determining healthcare outcomes. These results add to a growing body of literature demonstrating that comprehensive social support is paramount in improving SUD outcomes. Medical advocacy around SUD treatment should prioritize policy and programming that will increase the socioeconomic support provided in standard SUD treatment.