Compounding risks of chronic health conditions and substance use disorder on healthcare burden in the USA: Analysis of NSDUH data (2021-2023).

BACKGROUND

Emergency room (ER) use reflects acute healthcare burden, but the roles of chronic health conditions (CHCs), substance use disorders (SUDs), drug use disorders (DUDs), and mental health conditions (MHCs) remain underexplored across populations.

METHODS

Using nationally representative survey data (N = 226,838; weighted = 1,243,120,763), we applied survey-weighted logistic regression to examine predictors of ER visits. Covariates included CHCs, SUDs, DUDs, severity levels of these orders, MHCs, race/ethnicity, education, employment, residence, and body mass index.

RESULTS

Adults with ≥ 1 CHC were more likely to visit the ER (OR = 1.72; 95 % CI: 1.60-1.85). DUD significantly increased ER use (OR = 1.70; 95 % CI: 1.54-1.88), while overall SUD was not significant after adjustment (OR = 1.05; 95 % CI: 0.98-1.12). Severe SUD elevated ER use even without CHCs (OR = 1.89; 95 % CI: 1.67-2.13). African Americans had higher odds of ER visits (OR = 1.28; 95 % CI: 1.21-1.36), and Native American/Alaska Natives were more likely to report DUD (OR = 1.55; 95 % CI: 1.31-1.82). Lower educational attainment (OR = 1.22; 95 % CI: 1.16-1.28) and unemployment (OR = 1.34; 95 % CI: 1.25-1.43) were linked to higher risks. MHCs predicted ER use (OR = 1.63; 95 % CI: 1.53-1.74) and substance-related disorders.

CONCLUSIONS

CHCs, DUD severity, and MHCs are strong predictors of ER utilization. Disparities among African Americans and Native American/Alaska Natives highlight the need for integrated care addressing chronic illness, behavioral health, and substance use-particularly for socioeconomically and racially marginalized groups.