TY - JOUR
T1 - Racial, ethnic, and insurance status disparities in use of posthospitalization care after trauma
AU - Englum, Brian R.
AU - Villegas, Cassandra
AU - Bolorunduro, Oluwaseyi
AU - Haut, Elliott R.
AU - Cornwell, Edward E.
AU - Efron, David T.
AU - Haider, Adil H.
N1 - Funding Information:
Financial support for this work was provided by: National Institutes of Health/NIGMS K23GM093112-01 ; American College of Surgeons C James Carrico Fellowship for the Study of Trauma and Critical Care and Hopkins Center for Health Disparities Solutions (Dr Haider)
PY - 2011/12
Y1 - 2011/12
N2 - 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. Study Design: 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.
AB - 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. Study Design: 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.
KW - AIS
KW - Abbreviated Injury Scale
KW - GSC-M
KW - Glasgow Coma Scale Motor Score
KW - ISS
KW - Injury Severity Score
KW - LOS
KW - NTDB
KW - National Trauma Data Bank
KW - RRR
KW - TBI
KW - length of hospital stay
KW - relative risk ratio
KW - traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=81855166633&partnerID=8YFLogxK
U2 - 10.1016/j.jamcollsurg.2011.08.017
DO - 10.1016/j.jamcollsurg.2011.08.017
M3 - Article
C2 - 21958511
AN - SCOPUS:81855166633
SN - 1072-7515
VL - 213
SP - 699
EP - 708
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
IS - 6
ER -