Racial, Ethnic, and Regional Disparities of Post-Acute Service Utilization After Stroke in the United States.

IF 2.3 Q3 CLINICAL NEUROLOGY

Neurology. Clinical practice Pub Date : 2024-10-01 Epub Date: 2024-07-17 DOI:10.1212/CPJ.0000000000200329

Shumei Man, David Bruckman, Ken Uchino, Jesse D Schold, Jarrod Dalton

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Abstract

Background and objectives: Post-acute care is critical for patient functional recovery and successful community transition. This study aimed to understand the current racial, ethnic, and regional disparities in post-acute service utilization after stroke.

Methods: This retrospective cross-sectional study included patients hospitalized for ischemic stroke and intracerebral hemorrhage in 2017-2018 using the National Inpatient Sample. Discharge destinations were classified as follows: (1) facility including inpatient rehabilitation, skilled nursing facility, and facility hospice; (2) home health care (HHC), including home health and home hospice; and (3) home without HHC. Multinomial logistic regression was used to study the odds of discharge to a facility over home and HHC over home without HHC by race, ethnicity, insurance, and census division, adjusting for clinical factors and survey design.

Results: Among the 1,000,980 weighted ischemic stroke admissions, 66.9% were White, 17.6% Black, 9.5% Hispanic, 3.1% Asian American/Pacific Islander, and 0.4% Native American. Relative to private insurance, uninsured patients had the lowest adjusted odds of facility over home discharge (0.44; 95% CI 0.40-0.48) and HHC discharge over home without HHC (0.79; 95% CI 0.71-0.88). Compared with White patients, only Hispanic patients with Medicare/Medicaid insurance or self-pay had lower odds of facility over home discharge (adjusted OR 0.80 and 0.75, respectively; 95% CI 0.76-0.84 and 0.63-0.93). Uninsured Hispanic patients also had lower odds of HHC discharge over home without HHC than White patients (0.74; 95% CI 0.57-0.97). Facility discharge rate was the highest in East North Central (39.2%) and lowest in Pacific (31.2%). HHC discharge rate was the highest in New England (20.2%) and lowest in West North Central (10.3%), which had the highest home without HHC discharge (46.1%). Compared with New England, other census divisions had lower odds of facility over any home discharge with Pacific being the lowest (adjusted OR, 0.66; 95% CI 0.60-0.71) and HHC over home without HHC discharge with West North Central being the lowest (adjusted OR, 0.33; 95% CI 0.29-0.38). Similar patterns were observed in intracerebral hemorrhage.

Discussion: Significant insurance-dependent racial and ethnic disparities and regional variations were evident in post-acute service utilization after stroke. Targeted efforts are needed to improve post-acute service access for uninsured patients especially Hispanic patients and people in certain regions.

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美国中风后急性期服务使用的种族、民族和地区差异。

背景和目标：急性期后护理对患者的功能恢复和成功重返社区至关重要。本研究旨在了解目前中风后急性期服务利用的种族、民族和地区差异：这项回顾性横断面研究纳入了 2017-2018 年因缺血性中风和脑内出血住院的患者，使用的是全国住院患者样本。出院目的地分类如下：(1）设施，包括住院康复、专业护理设施和设施临终关怀；（2）家庭保健（HHC），包括家庭保健和家庭临终关怀；（3）无 HHC 的家庭。在对临床因素和调查设计进行调整后，我们使用多项式逻辑回归法研究了出院后去医疗机构而不是去家庭以及去 HHC 而不是去没有 HHC 的家庭的几率，并对种族、民族、保险和人口普查分区进行了分析：在 1,000,980 例加权缺血性卒中住院患者中，66.9% 为白人，17.6% 为黑人，9.5% 为西班牙裔，3.1% 为亚裔美国人/太平洋岛民，0.4% 为美洲原住民。相对于私人保险，未参保患者出院后入住医疗机构的调整后几率最低（0.44；95% CI 0.40-0.48），出院后入住 HHC 的调整后几率最低（0.79；95% CI 0.71-0.88）。与白人患者相比，只有拥有医疗保险/医疗补助保险或自费的西语裔患者出院时选择医疗机构而非居家的几率较低（调整后 OR 分别为 0.80 和 0.75；95% CI 分别为 0.76-0.84 和 0.63-0.93）。与白人患者相比，未参保的西班牙裔患者出院后入住 HHC 的几率也低于不入住 HHC 的患者（0.74；95% CI 0.57-0.97）。设施出院率最高的是东北部（39.2%），最低的是太平洋地区（31.2%）。HHC 出院率最高的是新英格兰地区（20.2%），最低的是中北部西部地区（10.3%），该地区没有 HHC 出院的家庭比例最高（46.1%）。与新英格兰地区相比，其他人口普查分区的设施出院率低于任何家庭出院率，其中太平洋地区最低（调整后 OR，0.66；95% CI 0.60-0.71），HHC 出院率低于无 HHC 的家庭出院率，中北部西部最低（调整后 OR，0.33；95% CI 0.29-0.38）。在脑出血中也观察到类似的模式：讨论：在中风后的急性期服务利用方面，与保险相关的种族和民族差异以及地区差异非常明显。需要有针对性地改善无保险患者，尤其是西班牙裔患者和某些地区的患者使用急性期后服务的情况。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurology. Clinical practice CLINICAL NEUROLOGY-

CiteScore

4.00

自引率

0.00%

发文量

期刊介绍： Neurology® Genetics is an online open access journal publishing peer-reviewed reports in the field of neurogenetics. The journal publishes original articles in all areas of neurogenetics including rare and common genetic variations, genotype-phenotype correlations, outlier phenotypes as a result of mutations in known disease genes, and genetic variations with a putative link to diseases. Articles include studies reporting on genetic disease risk, pharmacogenomics, and results of gene-based clinical trials (viral, ASO, etc.). Genetically engineered model systems are not a primary focus of Neurology® Genetics, but studies using model systems for treatment trials, including well-powered studies reporting negative results, are welcome.