Leveraging serially measured hospital data to characterize the impact of trauma on social risk

In trauma patients, frequent lack of preinjury social drivers of health data limits understanding of how social risk changes after an injury. However, at our institution, a social drivers of health screening tool implemented in 2019 offers insight into many trauma patients' baseline social risk. We aimed to identify social drivers of health domains most impacted after injury and factors associated with increased postinjury risk.

Adult trauma inpatients (2020-2024) who completed hospital-administered social drivers of health screening preinjury and postinjury were included. Change in self-reported risk was measured in 8 domains (eg, transportation needs and food insecurity) and categorized (eg, increased, stable, and decreased). McNemar's paired tests identified domains with significant proportions of patients reporting increased risk. Domain-specific multivariable regressions for increased risk were developed.

Among 1,055 included patients, 23.9% reported a net increase in social drivers of health risk postinjury, particularly in the domains of food insecurity (12% increased risk vs 7.4% decreased risk; P = .017), housing instability (11.9% vs 5%; P = .005), transportation needs (10.8% vs 6.7%; P = .02), and daily stress (19.3% vs 7.8%; P = .007). Younger patients were more likely to report increased risk of food insecurity (inverse odds ratio, 1.04 [1.02-1.06]; P < .001), housing instability (inverse odds ratio, 1.04 [1.01-1.08]; P = .016), financial strain (inverse odds ratio, 1.04 [1.01-1.08]; P = .007), and physical activity (inverse odds ratio, 0.94 [1.02-1.15]; P = .008).

A significant proportion of patients experienced increased social risk after trauma, especially for food insecurity, housing instability, transportation needs, and daily stress. Younger trauma patients were more vulnerable than older patients in multiple domains, including food and housing. Interventions targeting these domains may mitigate the socioeconomic consequences of traumatic injury.