Race and Insurance Disparities in Discharge to Rehabilitation for Patients with Traumatic Brain Injury
Race and Insurance Disparities in Discharge to Rehabilitation for Patients with Traumatic Brain Injury
复制标题
DOI：
10.1089/neu.2013.3091
复制
发表时间：
2013-12-15
影响因子：
4.2
通讯作者：
Schneider, Eric B.
中科院分区：
文献类型：
--
作者：
Asemota, Anthony O.;George, Benjamin P.;Schneider, Eric B.
急性期后住院康复服务与创伤性脑损伤（TBI）患者的功能结局改善相关。我们试图调查在获得康复方面的种族和保险差异。使用标准描述性方法和多变量logistic回归分析了2005-2010年全国住院患者样本的数据，以评估TBI后获得住院康复的基于种族和保险的差异，控制患者和医院水平的变量。年龄在18-64岁之间的中度至重度TBI患者，有完整的种族和保险状况数据，从住院治疗中活着出院，有资格参加研究。在307，675名符合研究标准并可能符合出院康复条件的TBI幸存者中，66%为白色，12%为黑人，15%为西班牙裔，2%为亚洲人，5%为其他少数民族。大多数白人（70%），亚洲人（70%），黑人（59%）和许多西班牙裔（49%）都有保险。与有保险的白人相比，有保险的黑人出院到康复的几率降低（比值比[OR] 0.84; 95%置信区间[CI] 0.75-0.95）。此外，投保的西班牙裔（OR 0.52; 95% CI 0.44-0.60）和投保的亚洲人（OR 0.54; 95% CI 0.39-0.73）出院康复的可能性低于投保的白人。与有保险的白人相比，（OR 0.57; 95% CI 0.51-0.63）、无保险的黑人（OR 0.33; 95% CI 0.26-0.42）、无保险的西班牙裔（OR 0.27; 95% CI 0.22-0.33）和无保险的亚洲人（OR 0.40; 95% CI 0.22-0.73）出院接受康复治疗的可能性较小。种族和保险是美国成年TBI幸存者出院到康复的强有力的预测因素。需要努力了解和消除创伤性脑损伤后康复机会方面的差距。
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.