University of Washington School of Medicine, Seattle, USA.
Center for Child Health, Behavior and Development, Seattle Children's Research Institute, PO Box 5371 CW 8/6, Seattle, WA, 98145, USA.
J Racial Ethn Health Disparities. 2020 Jun;7(3):571-576. doi: 10.1007/s40615-019-00686-6. Epub 2020 Jan 2.
Concussion is common and subspecialty care can be essential to ensure recovery. However, barriers may exist to accessing care. This study aimed to assess disparities in subspecialty concussion care related to ethnicity, limited English proficiency (LEP), and insurance status. We utilized logistic regression to analyze 2010-2015 administrative data from four Sports Medicine clinics, comparing odds of being seen for concussion to odds of being seen for fracture by ethnicity, insurance type, and interpreter usage, controlling for demographic factors. ICD-9 codes were used to identify concussion and fracture. Our final sample contained 25,294 subjects: 5621 with concussion and 19,673 with fracture. In bivariate analysis, youth seen for concussion had 83% lower odds of being Hispanic compared with youth seen for fracture (95%CI: 75-92%). Due to interactions between ethnicity and interpreter use, we utilized a stratified multivariate model as our final model. Youth with concussion had 1.8× greater odds of having private insurance compared with youth with fracture (Hispanic OR 1.8, 95% CI 1.5-2.3; Non-Hispanic OR 1.8, 95% CI 1.7-2.0). Youth with concussion also had greater odds of not using an interpreter, though the strength of this association was weaker for Hispanic youth compared with non-Hispanic youth (Hispanic OR 1.68, 95% CI 1.30-2.17; Non-Hispanic OR 4.36, 95% CI 3.00-6.35). Age and sex were included as covariates. In conclusion, our analysis suggests disparities in subspecialty concussion care for Hispanic youth, as well as for individuals with LEP and non-private insurance. Further research should explore means for improving access to concussion care for all youth.
脑震荡很常见，接受专业的亚专科治疗对于确保康复至关重要。然而，在获得治疗方面可能存在障碍。本研究旨在评估与族裔、英语水平有限（LEP）和保险状况相关的亚专科脑震荡治疗方面的差异。我们利用逻辑回归分析了来自四个运动医学诊所的 2010-2015 年管理数据，比较了通过族裔、保险类型和使用口译员就诊于脑震荡与就诊于骨折的几率，控制了人口统计学因素。ICD-9 编码用于识别脑震荡和骨折。我们的最终样本包含 25294 名患者：5621 名患有脑震荡，19673 名患有骨折。在单变量分析中，与就诊于骨折的患者相比，就诊于脑震荡的患者中，青年患者的西班牙裔人群的就诊几率低 83%（95%CI：75-92%）。由于族裔和口译员使用之间存在交互作用，我们使用分层多变量模型作为最终模型。与就诊于骨折的患者相比，就诊于脑震荡的患者更有可能拥有私人保险（西班牙裔 OR 1.8，95%CI 1.5-2.3；非西班牙裔 OR 1.8，95%CI 1.7-2.0）。就诊于脑震荡的患者也更有可能不使用口译员，尽管这种关联的强度对于西班牙裔患者来说弱于非西班牙裔患者（西班牙裔 OR 1.68，95%CI 1.30-2.17；非西班牙裔 OR 4.36，95%CI 3.00-6.35）。年龄和性别被纳入为协变量。总之，我们的分析表明，西班牙裔青年以及英语水平有限和非私人保险的个体在亚专科脑震荡治疗方面存在差异。进一步的研究应该探索改善所有青年获得脑震荡治疗的途径。
