Research Reports - Race and insurance disparities in discharge to rehabilitation for patients with TBI

J Neurotrauma. 2013 Aug 25

Asemota AO, George BP, Cumpsty-Fowler CJ, Haider AH, Schneider EB

Post-acute inpatient rehabilitation services are associated with improved
functional outcomes among individuals with traumatic brain injury (TBI). We
sought to investigate racial and insurance-based disparities in access to
rehabilitation. Data from the Nationwide Inpatient Sample from 2005-2010 were
analyzed using standard descriptive methods and multivariable logistic regression
to assess race- and insurance-based differences in access to inpatient
rehabilitation after TBI controlling for patient- and hospital-level variables.
Patients with moderate to severe TBI aged 18-64 years with complete data on race
and insurance status discharged alive from inpatient care were eligible for
study. Among 307,675 TBI survivors meeting study criteria and potentially
eligible for discharge to rehabilitation, 66% were white, 12% black, 15%
Hispanic, 2% Asian and 5% other ethnic minorities. Most whites (70%), Asians
(70%), blacks (59%), and many Hispanics (49%) had insurance. Compared with
insured whites, insured blacks had reduced odds of discharge to rehabilitation
(OR 0.84; 95% CI 0.75-0.95). Also, insured Hispanics (OR 0.52; 95% CI 0.44-0.60)
and insured Asians (OR 0.54; 95% CI 0.39-0.73) were less likely to be discharged
to rehabilitation than insured whites. Compared with insured whites, uninsured
whites (OR 0.57; 95% CI 0.51-0.63), uninsured blacks (OR 0.33; 95% CI 0.26-0.42),
uninsured Hispanics (OR 0.27; 95% CI 0.22-0.33), and uninsured Asians (OR 0.40;
95% CI 0.22-0.73) were less likely to be discharged to rehabilitation. Race and
insurance are strong predictors of discharge to rehabilitation among adult TBI
survivors in the US. Efforts are needed to understand and eliminate disparities
in access to rehabilitation after TBI.

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