Martinez Maylyn, Baccile Rachel, Johnson Joshua, Falvey Jason, Peek Monica E, Arora Vineet, Meltzer David
Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA.
Center for Health and Social Sciences, University of Chicago, Chicago, IL, USA.
J Gen Intern Med. 2025 Sep 18. doi: 10.1007/s11606-025-09826-7.
Black patients have poorer physical function and mobility compared to White patients but utilize physical rehabilitation services less.
To determine whether racial differences exist in physical function and post-acute care facility utilization and whether neighborhood social disadvantage influences these differences.
A cross-sectional study of hospitalized patients at a large urban academic hospital.
We included self-identified Black or White adults who were hospitalized between January 2018 and May 2022.
The main exposure was self-identified race. The exposure in our secondary aim was neighborhood social disadvantage measured by the Area Deprivation Index. Neighborhood disadvantage was categorized as "more" (deciles 6-10) vs. "less" (deciles 1-5). Primary outcomes included inpatient functional measures, inpatient and post-acute physical therapy referral, and discharge location.
Compared to White patients, Black patients had more functional impairment on admission [OR 1.52; 95% CI (1.37, 1.69)], poorer mobility change [β-0.83; 95% CI (- 1.16, 0.50)], more mobility loss [OR 1.25; 95% CI (1.12, 1.41)], but no statistically significant difference in inpatient PT referrals after adjusting for physical function. Most differences in function persisted when stratified by neighborhood disadvantage. Despite similar odds of recommendation for discharge to a PAC facility, Black patients had significantly lower odds of discharge to a facility [OR 0.53; 95% CI (0.42, 0.68). This difference persisted when stratified by more neighborhood disadvantage [OR 0.60; 95% CI (0.43, 0.85)] and less neighborhood disadvantage [OR 0.43; 95% CI (0.31, 0.61)].
In this study of patients hospitalized at a large urban academic medical center, Black patients had poorer functional outcomes yet nearly half the likelihood of discharging to a post-acute care facility compared to White patients. Race was a more consistent driver of disparities than neighborhood disadvantage. Hospital, healthcare system, and public policy changes are needed to improve discharge location appropriateness and recovery after hospitalization for vulnerable patients.
与白人患者相比，黑人患者的身体功能和活动能力较差，但较少使用物理康复服务。
确定身体功能和急性后期护理机构的使用情况是否存在种族差异，以及社区社会劣势是否会影响这些差异。
对一家大型城市学术医院的住院患者进行横断面研究。
我们纳入了在2018年1月至2022年5月期间住院的自我认定为黑人或白人的成年人。
主要暴露因素是自我认定的种族。我们次要目标中的暴露因素是通过地区剥夺指数衡量的社区社会劣势。社区劣势分为“更多”（十分位数6-10）和“更少”（十分位数1-5）。主要结局包括住院期间的功能测量指标、住院和急性后期物理治疗转诊情况以及出院地点。
与白人患者相比，黑人患者入院时功能障碍更多[比值比1.52；95%置信区间（1.37，1.69）]，活动能力变化较差[β-0.83；95%置信区间（-1.16，0.50）]，活动能力丧失更多[比值比1.25；95%置信区间（1.12，1.41）]，但在调整身体功能后，住院物理治疗转诊方面无统计学显著差异。按社区劣势分层时，大多数功能差异仍然存在。尽管被推荐出院到急性后期护理机构的几率相似，但黑人患者出院到这类机构的几率显著更低[比值比0.53；95%置信区间（0.42，0.68）]。按社区劣势更多[比值比0.60；95%置信区间（0.43，0.85）]和社区劣势更少[比值比0.43；95%置信区间（0.31，0.61）]分层时，这种差异仍然存在。
在这项对一家大型城市学术医疗中心住院患者的研究中，与白人患者相比，黑人患者的功能结局较差，但出院到急性后期护理机构的可能性几乎只有白人患者的一半。种族比社区劣势更能持续导致差异。需要医院、医疗保健系统和公共政策做出改变，以改善弱势患者住院后的出院地点适宜性和康复情况。
