An assessment of the non-fatal crash risks associated with substance use during rush and non-rush hour periods in the United States

• Published in: Drug and alcohol dependence Vol. 234; p. 109386
• Main Authors: Adeyemi, Oluwaseun J., Paul, Rajib, DiMaggio, Charles J., Delmelle, Eric M., Arif, Ahmed A.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-05-2022; Elsevier Science Ltd
• Subjects: Accidents, Traffic; Acuity; Alcohol use; Crash injuries; Drug abuse; Drug use; Emergency management; Emergency medical care; Emergency medical response; Emergency Medical Services; Emergency services; Health services; Humans; Injuries; Injury prevention; Injury severity; Logistic Models; Mortality; Non-fatal crash injury; Non-proportional ordinal logistic regression; Probability; Rush hour; Severity; Substance abuse; Substance use; Substance-Related Disorders - epidemiology; Traffic accidents & safety; Trauma; United States - epidemiology; Wounds and Injuries - epidemiology; United States; Substance use; Non-fatal crash injury; Non-proportional ordinal logistic regression; Rush hour; Emergency medical response; Injury severity
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2022.109386

Understanding how substance use is associated with severe crash injuries may inform emergency care preparedness.
This study aims to assess the association of substance use and crash injury severity at all times of the day and during rush (6–9 AM; 3–7 PM) and non-rush-hours. Further, this study assesses the probabilities of occurrence of low acuity, emergent, and critical injuries associated with substance use.
Crash data were extracted from the 2019 National Emergency Medical Services Information System. The outcome variable was non-fatal crash injury, assessed on an ordinal scale: critical, emergent, low acuity. The predictor variable was the presence of substance use (alcohol or illicit drugs). Age, gender, injured part, revised trauma score, the location of the crash, the road user type, and the geographical region were included as potential confounders. Partially proportional ordinal logistic regression was used to assess the unadjusted and adjusted odds of critical and emergent injuries compared to low acuity injury.
Substance use was associated with approximately two-fold adjusted odds of critical and emergent injuries compared to low acuity injury at all times of the day and during the rush and non-rush hours. Although the proportion of substance use was higher during the non-rush hour period, the interaction effect of rush hour and substance use resulted in higher odds of critical and emergent injuries compared to low acuity injury.
Substance use is associated with increased odds of critical and emergent injury severity. Reducing substance use-related crash injuries may reduce adverse crash injuries.
•Alcohol and illicit drugs were identified in about 10% of non-fatal crash injuries.•Substance use was associated with two-folds increased odds of worse injury severity.•Odds of substance use-related worse injury severity were higher during rush hours.•Probability of substance use-related emergent injury increased with increasing age.