Discharge Disposition Disparity for the Disabled - A National Trauma Data Bank Analysis
Suraj Panjwani1, Amanda Fazzalari2, John Alexander Palesty2, Mitchell Cahan3
1University of Massachusetts Medical School, Worcester, Massachusetts, United States, 2St. Mary"s Hospital, Waterbury, Connecticut, United States, 3Mount Auburn Hospital, Mount Auburn Hospital, Cambridge, MA, US, hospital, Cambridge, Massachusetts, United States
Objective Disability occurs universally, however being disabled in a minority population may come across as a substantial disadvantage. We sought to evaluate if patients that suffer a wheelchair fall have any socioeconomic health disparity in their care.
Design Retrospective Cohort Study
Setting National Trauma Data Bank 2012-2016
Patients Patients that presented with wheelchair falls. Demographic, patient and injury characters like age, gender, comorbidities, race, ethnicity, insurance status, and injury severity score (ISS) were evaluated.
Main Outcome Measures Independent predictors for hospital discharge disposition-rehabilitation facility vs. home
Results We analyzed 16,278 adult patients who suffered wheelchair falls. Mean age amongst all patients was 72 ± 14 years. Mean ISS was nine ± five. Only 30% self-pay patients were discharged to a rehabilitation facility compared to 56% and 65% for private and government insured patients respectively (p<0.0001). Similarly based on race and ethnicity, 56% non-white vs. 65% white (p<0.0001) and 54% Hispanic vs. 64% non-Hispanic individuals (p<0.0001) were discharged to a rehabilitation facility. After controlling for demographic characters like age, sex, patient comorbidities and injury severity, we found that socioeconomic factors such as self-pay status (Odds Ratio OR 0.33, 95% Confidence Intervals CI 0.23-0.48, p<0.0001), non-white race (OR 0.87, 95% CI 0.79-0.97, p=0.009), Hispanic ethnicity (OR 0.79, 95% CI 0.67-0.93, p=0.007) were independent negative predictors for discharge to a rehabilitation facility.
Conclusion Socioeconomic disparities are prevalent in patients already physically disabled at baseline when it comes to appropriate disposition post hospitalization care. Further investigation and measures to address these inequalities are warranted.
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