Racial/ethnic and insurance status disparities in post-hospitalization care for patients with traumatic brain injury

BACKGROUND: Professional, post-hospitalization care (PHC) can improve outcomes among patients who sustain traumatic brain injury (TBI). We examined racial/ethnic and insurance disparities in PHC among adults hospitalized for unintentional TBI in Oregon.

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: 0.42–0.91) than Non-Hispanic Whites. Compared to patients with private insurance, uninsured patients were less likely to be discharged to PHC (OR: 0.21; CI: 0.11–0.41) while patients with public insurance (OR: 1.74; CI: 1.42–2.14) and worker's compensation (OR: 1.57; CI: 1.13–2.18) 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.