Racial disparities in post-discharge healthcare utilization after trauma

Shelby Chun Fat; Juan P Herrera-Escobar; Anupamaa J Seshadri; Syeda S Al Rafai; Zain G Hashmi; Elzerie de Jager; Constantine Velmahos; George Kasotakis; George Velmahos; Ali Salim; Adil H Haider; Deepika Nehra

doi:10.1016/j.amjsurg.2019.03.024

Racial disparities in post-discharge healthcare utilization after trauma

Am J Surg. 2019 Nov;218(5):842-846. doi: 10.1016/j.amjsurg.2019.03.024. Epub 2019 Apr 1.

Affiliations

¹ Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H Chan School of Public Health, Boston, MA, USA.
² Department of Surgery, Division of Trauma, Burn and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
³ Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Department of Surgery, Division of Trauma, Acute Care Surgery & Surgical Critical Care, Boston University School of Medicine, Boston, MA, USA.
⁵ Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H Chan School of Public Health, Boston, MA, USA; Department of Surgery, Division of Trauma, Burn and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁶ Department of Surgery, Division of Trauma, Burn and Surgical Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: dnehra@bwh.harvard.edu.

PMID: 30954233
DOI: 10.1016/j.amjsurg.2019.03.024

Abstract

Background: Racial disparities in trauma outcomes have been documented, but little is known about racial differences in post-discharge healthcare utilization. This study compares the utilization of post-discharge healthcare services by African-American and Caucasian trauma patients.

Methods: Trauma patients with an Injury Severity Score (ISS)≥9 from three Level-I trauma centers were contacted between 6 and 12 months post-injury. Utilization of trauma-related healthcare services was asked. Coarsened exact matching (CEM) was used to match African-American and Caucasian patients. Conditional logistic regression then compared matched patients in terms of post-discharge healthcare utilization.

Results: 182 African-American and 1,117 Caucasian patients were followed. Of these, 141 African-Americans were matched to 628 Caucasians. After CEM, we found that African-American patients were less likely to use rehabilitation services [OR:0.64 (95% CI:0.43-0.95)] and had fewer injury-related outpatient visits [OR:0.59 (95% CI:0.40-0.86)] after discharge.

Conclusions: This study shows the existence of racial disparities in post-discharge healthcare utilization after trauma for otherwise similarly injured, matched patients.

Keywords: Long-term outcomes; Patient-reported; Post-discharge; Racial disparities; Rehabilitation utilization; Trauma.

Publication types

Multicenter Study

MeSH terms

Adult
Aged
Black or African American*
Boston / epidemiology
Facilities and Services Utilization / statistics & numerical data*
Female
Health Services Accessibility / statistics & numerical data
Healthcare Disparities / ethnology*
Healthcare Disparities / statistics & numerical data
Humans
Injury Severity Score
Logistic Models
Male
Middle Aged
Patient Acceptance of Health Care / ethnology*
Patient Acceptance of Health Care / statistics & numerical data
Patient Discharge*
Trauma Centers
White People*
Wounds and Injuries / ethnology
Wounds and Injuries / therapy*