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The following is a summary of “Racial, Ethnic, and Regional Disparities of Post-Acute Service Utilization After Stroke in the United States,” published in the July 2024 issue of Neurology by Man, et al.
Post-acute care is pivotal after stroke onset. The following study provides a deeper insight into the role of acute service utilization in stroke recovery.
Researchers conducted a retrospective study investigating racial, ethnic, and geographic disparities in post-acute stroke care utilization.
They involved patients with ischemic stroke and intracerebral hemorrhage(2017–2018). Discharge destinations were stratified into facilities, including inpatient rehabilitation, skilled nursing facilities, facility hospices, home health care (HHC), home health and home hospice, and Homes without HHC. Multinomial logistic regression was used to analyze discharge odds to a facility or HHC vs. home, considering race, ethnicity, insurance, census division, clinical factors, and survey design.
The result showed 1,000,980 patients admitted for ischemic stroke, with Native Americans (0.4%), Asian American/Pacific Islander(3.1%), Hispanic (9.5%), Black (17.6%), and White (66.9%).In patients with private insurance vs. those without insurance, the lowest adjusted odds of facility over-home discharge were (0.44; 95% CI 0.40–0.48) and HHC discharge over-home without HHC (0.79; 95% CI 0.71–0.88).
Patients of Hispanic ethnicity with Medicare/Medicaid or self-pay had lesser odds of facility discharge (0.80 and 0.75; 95% CI 0.76–0.84 and 0.63–0.93) vs. patients of White origin. Patients (Hispanic) without insurance also had lower odds of HHC discharge (0.74; 95% CI 0.57–0.97). Facility discharge rates were most prominent in the East-North central region (39.2%) and lowest in the Pacific region (31.2%). The HHC discharge rate was highest in New England (20.2%) and lowest in the West-North central region (10.3%), which had the highest rate of home discharge without HHC (46.1%). Compared to New England, all other census divisions had lower odds of facility discharge over home, with the Pacific region being the lowest (aOR, 0.66; 95% CI 0.60–0.71). The odds of HHC discharge over the home without HHC were lowest in the West-North central region (aOR, 0.33; 95% CI 0.29–0.38), and cases of intracerebral hemorrhage showed similar patterns.
Investigators concluded that significant insurance-dependent variations in racial, ethnic, and regional aspects were evident in post-acute service utilization after stroke. Further studies in the concerned area suggested enhancing the post-acute service access for patients without insurance.
Source: neurology.org/doi/10.1212/CPJ.0000000000200329
