Hospitalization and acute care utilization after substance use disorder–related emergency department visits among deaf or hard of hearing youth

Introduction Youth with hearing loss face challenges such as communication barriers in acute care settings and increased risk for substance use. Yet the association between hearing loss and healthcare utilization following substance use disorder (SUD)-related emergency department (ED) visits has not been examined.Methods We conducted a retrospective cohort study using 2016-2019 State Emergency Department and State Inpatient Databases from New York and Maryland. Youth aged 15-24 with documented hearing loss and SUD-related ED visits were identified. A 1:5 propensity score-matched cohort was constructed using nearest-neighbor matching with a caliper of 0.2 standard deviations of the logit of the propensity score. Mixed-effects regression models with a hospital-level random intercept estimated associations between hearing loss and hospitalization following an ED visit, ED revisit within 30 days of discharge, inpatient length of stay, hospitalization costs, and hospitalization cost per day.Results The cohort included 287 youths with documented hearing loss and 1435 matched peers without documented hearing loss. Hearing loss was associated with higher odds of hospitalization (adjusted odds ratio [aOR] 4.12; 95% CI, 2.78-6.10). Among hospitalized youth, hearing loss was associated with higher total hospitalization costs (adjusted mean ratio [aMR] 1.18; 95% CI, 1.04-1.34), but not length of stay (aMR 1.11; 95% CI, 0.98-1.25) or 30-day ED revisits (aOR 0.92; 95% CI, 0.63-1.33). No significant association between hearing loss and cost per day was observed in the primary analysis (aMR 1.08; 95% CI, 0.99-1.17), but several sensitivity analyses suggested higher cost per inpatient day among youth with hearing loss.Conclusion Among youth with SUD-related ED visits in New York and Maryland during 2016-2019, documented hearing loss was associated with higher odds of hospitalization and higher total hospitalization costs. In addition, hearing loss was associated with higher cost per inpatient day in several sensitivity analyses. These findings suggest that youth with hearing loss may have greater clinical or care coordination needs at ED presentation or during hospitalization. Strategies to improve communication access, support earlier SUD identification, and strengthen accessible outpatient behavioral health services may help address acute care needs in this population.