title: Race and insurance disparities in discharge to rehabilitation for patients with traumatic brain injury.
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.
authors: 1 Department of Neurology/Neurosurgery, Johns Hopkins School of Medicine , Baltimore, Maryland.
authors: Anthony O
authors: AO
authors: Asemota
authors: Benjamin P
authors: BP
authors: George
authors: Carolyn J
authors: CJ
authors: Cumpsty-Fowler
authors: Adil H
authors: AH
authors: Haider
authors: Eric B
authors: EB
authors: Schneider
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000191:economics / Q000208:ethnology* / Q000534:rehabilitation*; D003266:Continuity of Patient Care / Q000191:economics; D005260:Female; D054625:Healthcare Disparities / Q000191:economics / Q000208:ethnology; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D007348:Insurance, Health / Q000191:economics; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000191:economics; D044469:Racial Groups / Q000208:ethnology*; D055815:Young Adult
references: Am J Public Health. 2004 Dec;94(12):2055-8
references: 15569950
references: J Trauma. 2011 Nov;71(5):1172-8
references: 22071922
references: Arch Phys Med Rehabil. 2004 Jun;85(6):943-50
references: 15179648
references: Am J Public Health. 2003 Oct;93(10):1619-21
references: 14534208
references: Mt Sinai J Med. 2009 Apr;76(2):105-10
references: 19306375
references: Med Care. 2007 Jul;45(7):686-90
references: 17571018
references: J Head Trauma Rehabil. 2011 Jan-Feb;26(1):20-9
references: 21209560
references: J Trauma. 2011 Oct;71(4):1011-5
references: 21399544
references: J Trauma. 2007 Nov;63(5):1138-42
references: 17993963
references: Arch Phys Med Rehabil. 2008 Dec;89(12):2239-49
references: 19061735
references: J Head Trauma Rehabil. 2003 Sep-Oct;18(5):408-24
references: 12973271
references: Inj Prev. 2006 Apr;12(2):67-8
references: 16595417
references: Arch Phys Med Rehabil. 2011 May;92(5):721-730.e3
references: 21530719
references: Disabil Rehabil. 2012;34(11):904-9
references: 22148905
references: J Trauma. 2007 Dec;63(6):1364-9
references: 18212662
references: J Trauma. 2002 Aug;53(2):219-23; discussion 223-4
references: 12169925
references: Am J Public Health. 2004 May;94(5):866-9
references: 15117713
references: J Trauma. 2004 Feb;56(2):284-90
references: 14960969
references: J Neurotrauma. 1995 Aug;12(4):601-10
references: 8683611
references: Lancet Neurol. 2008 Aug;7(8):728-41
references: 18635021
references: JAMA. 1999 Sep 8;282(10):974-83
references: 10485684
references: World J Surg. 2009 Jan;33(1):23-33
references: 19023623
references: Acad Emerg Med. 2003 Nov;10(11):1209-17
references: 14597497
references: Med Care Res Rev. 2007 Oct;64(5 Suppl):7S-28S
references: 17881624
references: Perspect Biol Med. 2005 Winter;48(1 Suppl):S42-53
references: 15842086
references: MMWR Surveill Summ. 2011 May 6;60(5):1-32
references: 21544045
references: J Head Trauma Rehabil. 2005 Mar-Apr;20(2):158-72
references: 15803039
references: J Head Trauma Rehabil. 2003 Mar-Apr;18(2):128-38
references: 12802222
references: Psychol Med. 2011 Jan;41(1):71-83
references: 20346193
references: JAMA. 2000 Jun 21;283(23):3075-81
references: 10865301
references: Med Care Res Rev. 2000;57 Suppl 1:181-217
references: 11092163
references: Brain Inj. 2009 Sep;23(10):775-89
references: 19697166
references: J Am Coll Surg. 2011 Dec;213(6):699-708
references: 21958511
references: J Neurotrauma. 2011 Oct;28(10):2019-31
references: 21787177
references: Brain Inj. 1989 Jul-Sep;3(3):301-13
references: 2758192
references: J Head Trauma Rehabil. 2007 Mar-Apr;22(2):113-21
references: 17414313
references: Arch Phys Med Rehabil. 2005 Dec;86(12):2296-302
references: 16344026
references: Health Serv Res. 2012 Jun;47(3 Pt 1):1158-78
references: 22172017
references: Brain Inj. 2007 Jun;21(7):701-8
references: 17653944
references: J Trauma. 2007 Dec;63(6):1263-8; discussion 1268-70
references: 18212648
references: Brain Inj. 1990 Apr-Jun;4(2):183-90
references: 2331548
references: Health Aff (Millwood). 2005 Mar-Apr;24(2):499-505
references: 15757936
references: Milbank Q. 2006;84(1):111-33
references: 16529570
references: J Head Trauma Rehabil. 2007 Mar-Apr;22(2):95-104
references: 17414311
references: Disabil Rehabil. 2004 Mar 4;26(5):253-61
references: 15200240
references: Am J Public Health. 2010 Aug;100(8):1462-9
references: 20558800