Research Reports - Race and insurance disparities in discharge to rehabilitation for patients with traumatic brain injury

J Neurotrauma. 2013 Dec 15;30(24):2057-65

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

Abstract Post-acute inpatient rehabilitation services are associated with
improved functional outcomes among persons 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
(odds ratio [OR] 0.84; 95% confidence interval [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 United
States. Efforts are needed to understand and eliminate disparities in access to
rehabilitation after TBI.

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