The Association of Injury With Substance Use Disorder Among Women of Reproductive Age: An Opportunity to Address a Major Contributor to Recurrent Preventable Emergency Department Visits?

Abstract

Objectives: Substance use disorder (SUD) among women of reproductive age is a complex public health problem affecting a diverse spectrum of women and their families, with potential consequences across generations. The goals of this study were 1) to describe and compare the prevalence of patterns of injury requiring emergency department (ED) visits among SUD-positive and SUD-negative women and 2) among SUD-positive women, to investigate the association of specific categories of injury with type of substance used.Methods: This study was a secondary analysis of a large, multisource health care utilization data set developed to analyze SUD prevalence, and health and substance abuse treatment outcomes, for women of reproductive age in Massachusetts, 2002 through 2008. Sources for this linked data set included diagnostic codes for ED, inpatient, and outpatient stay discharges; SUD facility treatment records; and vital records for women and for their neonates.Results: Injury data (ICD-9-CM E-codes) were available for 127,227 SUD-positive women. Almost twothirds of SUD-positive women had any type of injury, compared to 44.8% of SUD-negative women. The mean (AESD) number of events also differed (2.27 AE 4.1 for SUD-positive women vs. 0.73 AE 1.3 for SUDnegative women, p < 0.0001). For four specific injury types, the proportion injured was almost double for SUD-positive women (49.3% vs 23.4%), and the mean (AESD) number of events was more than double (0.72 AE 0.9 vs. 0.26 AE 0.5, p < 0.0001). The numbers and proportions of motor vehicle incidents and falls were significantly higher in SUD-positive women (22.5% vs. 12.5% and 26.6% vs. 11.0%, respectively), but the greatest differences were in self-inflicted injury (11.5% vs. 0.8%; mean AE SD events = 0.19 AE 0.9 vs. 0.009 AE 0.2, p < 0.0001) and purposefully inflicted injury (11.5% vs 1.9%, mean AE SD events = 0.18 AE 0.1 vs. 0.02 AE 0.2, p < 0.0001). In each of the injury categories that we examined, injury rates among SUD-positive women were lowest for alcohol disorders only and highest for alcohol and drug disorders combined. Among 33,600 women identified as using opioids, 2,132 (6.3%) presented to the ED with overdose. Multiple overdose visits were common (mean AE SD = 3.67 AE 6.70 visits). After adjustment for sociodemographic characteristics, psychiatric history, and complex/chronic illness, SUD remained a significant risk factor for all types of injury, but for the suicide/self-inflicted injury category, psychiatric history was by far the stronger predictor.

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