National analysis of health-related social needs among adult injury survivors

Alexandra H Hernandez; Nina M Clark; Erika Bisgaard; Deepika Nehra; Barclay T Stewart; Alexander Malloy; Eileen M Bulger; Joseph L Dieleman; Douglas Zatzick; John W Scott

doi:10.1097/TA.0000000000004508

National analysis of health-related social needs among adult injury survivors

J Trauma Acute Care Surg. 2025 Jan 6. doi: 10.1097/TA.0000000000004508. Online ahead of print.

Authors

Alexandra H Hernandez¹, Nina M Clark, Erika Bisgaard, Deepika Nehra, Barclay T Stewart, Alexander Malloy, Eileen M Bulger, Joseph L Dieleman, Douglas Zatzick, John W Scott

Affiliation

¹ From the Department of Surgery (A.H.H., N.M.C., B.T.S.), Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery (E.B., D.N., B.T.S., A.M., E.M.B., J.W.S.), and Department of Health Metrics Sciences (J.L.D., J.W.S.), Institute for Health Metrics and Evaluation, University of Washington; Psychiatry and Behavioral Sciences (D.Z.), University of Washington School of Medicine, Seattle, Washington.

PMID: 39760832
DOI: 10.1097/TA.0000000000004508

Abstract

Background: Despite advances in trauma care, the effects of social determinants of health continue to be a barrier to optimal health outcomes. Health-related social needs (HRSNs), now the basis of a Centers for Medicare and Medicaid Services national screening program, may contribute to poor health outcomes, inequities, and low-value care, but the impact of HRSNs among injured patients remains poorly understood at the national level.

Methods: Using data from the nationally representative 2021 Medical Expenditure Panel Survey, injured patients were matched with uninjured controls via coarsened exact matching on age and sex. We then determined the prevalence of HRSNs based on core needs identified by Centers for Medicare and Medicaid Services: food, utilities, living situation, transportation, and personal safety. We used multivariable regression models to evaluate the association between HRSNs and health, delays in care, and emergency department visits.

Results: Overall, 43% of injured patients reported one or more HRSNs. Compared with uninjured controls, injured patients were more likely to have unmet needs in all five HRSN domains (adjusted odds ratio, 1.44-2.00; p < 0.05 for all). In stratified analyses, HRSNs were highest among patients with lower income (65.1%), those who identified as Non-Hispanic Black patients (61.3%), and patients with Medicaid (66.1%). Increasing number of HRSNs was associated with worse physical and mental health (p < 0.05). Injured patients with three or more HRSNs were also more likely to delay care because of cost (adjusted odds ratio, 3.79; 95% confidence interval, 2.29-6.27) and had greater emergency department utilization (adjusted incidence rate ratio, 1.47; 95% confidence interval, 1.16-1.87).

Conclusion: In this nationally representative study, nearly half of injured patients had one or more HRSNs. Greater numbers of HRSNs were associated with worse health outcomes, delayed care, and low-value care. As national screening for HRSNs is implemented, strategies to address these factors are needed and may serve to optimize health and health care utilization among injury survivors.

Level of evidence: Prognostic and Epidemiological; Level III.