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Updated: Jul 12, 2025

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Published on: September 30, 2020
Substance use and pre-hospital crash injury severity among U.S. older adults: A five-year national cross-sectional
Oluwaseun Adeyemi1, Marko Bukur2, Cherisse Berry2
1Ronald O Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York, United States of America.
Background:
Alcohol and drug use (substance use) is a risk factor for crash involvement.
Objectives:
To assess the association between substance use and crash injury severity among older adults and how the relationship differs by rurality/urbanicity.
Methods:
We pooled 2017-2021 cross-sectional data from the United States National Emergency Medical Service (EMS) Information System. We measured injury severity (low acuity, emergent, critical, and fatal) predicted by substance use, defined as self-reported or officer-reported alcohol and/or drug use. We controlled for age, sex, race/ethnicity, road user type, anatomical injured region, roadway crash, rurality/urbanicity, time of the day, and EMS response time. We performed a partial proportional ordinal logistic regression and reported the odds of worse injury outcomes (emergent, critical, and fatal injuries) compared to low acuity injuries, and the predicted probabilities by rurality/urbanicity.
Results:
Our sample consisted of 252,790 older adults (65 years and older) road users. Approximately 67%, 25%, 6%, and 1% sustained low acuity, emergent, critical, and fatal injuries, respectively. Substance use was reported in approximately 3% of the population, and this proportion did not significantly differ by rurality/urbanicity. After controlling for patient, crash, and injury characteristics, substance use was associated with 36% increased odds of worse injury severity. Compared to urban areas, the predicted probabilities of emergent, critical, and fatal injuries were higher in rural and suburban areas.
Conclusion:
Substance use is associated with worse older adult crash injury severity and the injury severity is higher in rural and suburban areas compared to urban areas.
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