Racial/ethnic and insurance status disparities in post-hospitalization care for patients with traumatic brain injury
METHODS: We utilized Oregon Hospital Discharge Data from 2008-2011. Patients hospitalized for unintentional TBI were identified using diagnosis and external-cause-of-injury codes. Receipt of PHC was assessed based on discharge disposition. Multivariable logistic regression was used to estimate the effects of race/ethnicity and insurance status on receipt of PHC while controlling for potential confounders. Generalized estimating equations were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) while accounting for clustering of data by hospital.
RESULTS: 6,997 records were included in the analyses. Overall, 28% of patients were discharged to PHC; this proportion was greater for Non-Hispanic White (32%) than Non-Hispanic Other (20%), Non-Hispanic Black (17%) and Hispanic patients (11%). Few uninsured patients were discharged to PHC (3%). While controlling for potential confounders, Hispanics were less likely to be discharged to PHC (OR: 0.62; CI: 0.420.91) than Non-Hispanic Whites. Compared to patients with private insurance, uninsured patients were less likely to be discharged to PHC (OR: 0.21; CI: 0.110.41) while patients with public insurance (OR: 1.74; CI: 1.422.14) and worker's compensation (OR: 1.57; CI: 1.132.18) were more likely to be discharged to PHC.
CONCLUSIONS: Results suggest racial/ethnic and insurance disparities exist with regard to receiving post-acute care after hospitalization for TBI. Future research should examine factors that might contribute to and reduce these inequities in care.
Learning Areas:Diversity and culture
Provision of health care to the public
Public health or related research
Compare rates of discharge to post-hospitalization care after traumatic brain injury between adult patients of differing race/ethnicity and with different insurance types. Identify the effects of race/ethnicity and insurance status on likelihood of discharge to post-hospitalization care among adults hospitalized with traumatic brain injury in the state of Oregon, from 2008-2011.
Keyword(s): Traumatic Brain Injury, Health Disparities
Qualified on the content I am responsible for because: I am trained in injury epidemiology and have conducted injury prevention research for over 10 years.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.