1 Department of Neurology/Neurosurgery, Johns Hopkins School of Medicine , Baltimore, Maryland.
J Neurotrauma. 2013 Dec 15;30(24):2057-65. doi: 10.1089/neu.2013.3091. Epub 2013 Nov 6.
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.
急性后期住院康复服务与创伤性脑损伤（TBI）患者的功能改善相关。我们旨在研究康复机会方面的种族和保险差异。使用标准描述性方法和多变量逻辑回归分析了 2005 年至 2010 年全国住院患者样本的数据，以评估 TBI 后住院康复机会方面的种族和保险差异，同时控制患者和医院层面的变量。符合研究标准且种族和保险状况数据完整的、年龄在 18-64 岁之间、从住院治疗中存活出院的中重度 TBI 患者有资格参与研究。在 307675 名符合研究条件且有资格出院康复的 TBI 幸存者中，66%为白人，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%）和许多西班牙裔人（49%）都有保险。与有保险的白人相比，有保险的黑人接受康复治疗的可能性降低（优势比 [OR] 0.84；95%置信区间 [CI] 0.75-0.95）。此外，有保险的西班牙裔（OR 0.52；95%CI 0.44-0.60）和有保险的亚洲人（OR 0.54；95%CI 0.39-0.73）接受康复治疗的可能性也低于有保险的白人。与有保险的白人相比，无保险的白人（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）接受康复治疗的可能性也较低。在美国，种族和保险是成人 TBI 幸存者接受康复治疗的重要预测因素。需要努力了解和消除 TBI 后康复机会方面的差异。
