title: Racial, ethnic, and insurance status disparities in use of posthospitalization care after trauma.
abstract: BACKGROUND
  Posthospitalization care is important for recovery after trauma. Disadvantaged populations, like racial or ethnic minorities and the uninsured, make up substantial percentages of trauma patients, but their use of posthospitalization facilities is unknown.
  
  
  METHODS
  This study analyzed National Trauma Data Bank admissions from 2007 for 18- to 64-year-olds and estimated relative risk ratios (RRR) of discharge to posthospitalization facilities--home, home health, rehabilitation, or nursing facility--by race, ethnicity, and insurance. Multinomial logistic regression adjusted for patient characteristics including age, sex, Injury Severity Score, mechanism of injury, and length of stay, among others.
  
  
  RESULTS
  There were 136,239 patients who met inclusion criteria with data for analysis. Most patients were discharged home (78.9%); fewer went to home health (3.3%), rehabilitation (5.0%), and nursing facilities (5.4%). When compared with white patients in adjusted analysis, relative risk ratios of discharge to rehabilitation were 0.61 (95% CI 0.56, 0.66) and 0.44 (95% CI 0.40, 0.49) for blacks and Hispanics, respectively. Compared with privately insured white patients, Hispanics had lower rates of discharge to rehabilitation whether privately insured (RRR 0.45, 95% CI 0.40, 0.52), publicly insured (RRR 0.51, 95% CI 0.42, 0.61), or uninsured (RRR 0.20, 95% CI 0.17, 0.24). Black patients had similarly low rates: private (RRR 0.63, 95% CI 0.56, 0.71), public (RRR 0.72, 95% CI 0.63, 0.82), or uninsured (RRR 0.27, 95% CI 0.23, 0.32). Relative risk ratios of discharge to home health or nursing facilities showed similar trends among blacks and Hispanics regardless of insurance, except for black patients with insurance whose discharge to nursing facilities was similar to their white counterparts.
  
  
  CONCLUSIONS
  Disadvantaged populations have more limited use of posthospitalization care such as rehabilitation after trauma, suggesting a potential improvement in trauma care for the underprivileged.
authors.affiliation: Center for Surgical Trials and Outcomes Research, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Englum
authors.forename: Cassandra
authors.initials: C
authors.lastname: Villegas
authors.forename: Oluwaseyi
authors.initials: O
authors.lastname: Bolorunduro
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cornwell
authors.forename: David T
authors.initials: DT
authors.lastname: Efron
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006630:Hispanic or Latino; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States; D044465:White People; D014947:Wounds and Injuries / Q000208:ethnology / Q000628:therapy; D055815:Young Adult