Research Reports - Racial and ethnic disparities in discharge to rehabilitation following traumatic brain injury

J Neurosurg. 2014 Nov 21:1-7

Meagher AD(1), Beadles CA, Doorey J, Charles AG

OBJECT Disparities in access to inpatient rehabilitation services after traumatic
brain injury (TBI) have been identified, but less well described is the
likelihood of discharge to a higher level of rehabilitation for Hispanic or black
patients compared with non-Hispanic white patients. The authors investigate
racial disparities in discharge destination (inpatient rehabilitation vs skilled
nursing facility vs home health vs home) following TBI by using a nationwide
database and methods to address racial differences in prehospital
characteristics. METHODS Analysis of discharge destination for adults with
moderate to severe TBI was performed using National Trauma Data Bank data for the
years 2007-2010. The authors performed propensity score weighting followed by
ordered logistic regression in their analytical sample and in a subgroup analysis
of older adults with Medicare. Likelihood of discharge to a higher level of
rehabilitation based on race/ethnicity accounting for prehospital and in-hospital
variables was determined. RESULTS The authors identified 299,205 TBI incidents:
232,392 non-Hispanic white, 29,611 Hispanic, and 37,202 black. Propensity
weighting resulted in covariate balance among racial groups. Hispanic (adjusted
OR 0.71, 95% CI 0.68-0.75) and black (adjusted OR 0.94, 95% CI 0.91-0.97)
populations were less likely to be discharged to a higher level of rehabilitation
than were non-Hispanic whites. The subgroup analysis indicated that Hispanic
(adjusted OR 0.79, 95% CI 0.71-0.86) and black (OR 0.87, 95% CI 0.81-0.94)
populations were still less likely to receive a higher level of rehabilitation,
despite uniform insurance coverage (Medicare). CONCLUSIONS Adult Hispanic and
black patients with TBI are significantly less likely to receive intensive
rehabilitation than their non-Hispanic white counterparts; notably, this
difference persists in the Medicare population (age ≥ 65 years), indicating that
uniform insurance coverage alone does not account for the disparity. Given that
insurance coverage and a wide range of prehospital characteristics do not
eliminate racial disparities in discharge destination, it is crucial that
additional unmeasured patient, physician, and institutional factors be explored
to eliminate them.

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