Racial and Ethnic Disparities in Discharge to Rehabilitation Following Burn Injury

Abstract

Racial and ethnic disparities in access to inpatient rehabilitation have been previously described for various injury groups; however, no studies have evaluated whether such disparities exist among burn patients. Their aim was to determine if racial disparities in discharge destination (inpatient rehabilitation, skilled nursing facility, home with home health, or home) following burn injury existed in this single-institution study. A retrospective analysis of all adult burn patients admitted to UNC Jaycee Burn Center from 2002 to 2012 was conducted. Patient characteristics included age, gender, burn mechanism, insurance status, percentage total body surface area (%TBSA) burned, presence of inhalation injury, and hospital length of stay. Patients were categorized into one of three mutually exclusive racial or ethnic groups: White, Hispanic, or Black. Propensity score weighting followed by ordered logistic regression was performed in the analytical sample and in a subgroup analysis of patients with severe burns (TBSA > 20%). For analysis, 4198 patients were included: 2661 White, 340 Hispanic, and 1197 Black. Propensity weighting resulted in covariate balance among racial groups. Black patients (OR: 1.58, 95% CI: 1.23-2.03; P < .001) were more likely than Whites to be discharged to a higher level of rehabilitation, whereas Hispanics were less likely (OR: 0.78, 95% CI: 0.38-1.58; P = .448). In their subgroup analysis, Black (OR: 1.88, 95% CI: 1.07-3.28; P = .026) and Hispanic (OR: 1.53, 95% CI: 0.31-7.51; P = .603) patients were more likely to discharge to a higher level of rehabilitation than White patients. Racial and ethnic disparities in discharge destination to a higher level of rehabilitative services among burn-injured patients exist particularly for Hispanic patients but not for Black or White burn patient groups. Further studies are needed to elucidate the potential sources of these disparities specifically for Hispanic patients.

Race, ethnicity, and utilization of outpatient rehabilitation for treatment of post COVID‐19 condition

“…Reliance on these largely incomplete and skewed data would have introduced biases, as the information was restricted to individuals with the most severe COVID‐19 cases, who required hospitalization for treatment of their SARS‐CoV‐2 infection. Although this limitation may have contributed to some of the observed disparity in utilization of rehabilitation services for post COVID‐19 condition in our sample, our findings are consistent with those of previous studies assessing racial differences in rehabilitation utilization for a variety of conditions, which have consistently reported that African American/Black patients underutilize or are under‐referred to therapy services relative to their White counterparts, even after controlling for insurance coverage and socioeconomic status 28,31,34 …”

“…Numerous studies have shown that African American/Black and Hispanic patients receive rehabilitation at lower rates than White patients across a variety of practice settings and diagnoses, with access to care impacted by a variety of factors including insurance status, type of insurance coverage, under-referral, transportation and other accessibility barriers, and racial bias. 28,[31][32][33][34] In exploring rehabilitation services for COVID-19, Ambrose et al (2021) found that during acute hospitalization for COVID-19, African American/ Black patients received inpatient physical therapy services less frequently than patients of any other race despite similar comorbidity scores. 35 Research exploring the predictive demographic factors for post COVID-19 condition and therapy utilization is limited, in some cases by lack of robust demographic information available at the time of data collection.…”

“…Although this limitation may have contributed to some of the observed disparity in utilization of rehabilitation services for post COVID-19 condition in our sample, our findings are consistent with those of previous studies assessing racial differences in rehabilitation utilization for a variety of conditions, which have consistently reported that African American/Black patients underutilize or are under-referred to therapy services relative to their White counterparts, even after controlling for insurance coverage and socioeconomic status. 28,31,34 Other important limitations merit comment. Our sample selection strategy relied on evidence of a COVID-positive test.…”

Disparities Associated with Discharge Patterns in Firearm-Associated Ocular Trauma

“…Additionally, uninsured patients may have declined rehabilitation placement to reduce the financial burden of their injury . Similar trauma studies using different data sources support findings of race and ethnicity and insurance-related discharge disparities …”

An Analysis of Racial Diversity in the Breast Reconstruction and Aesthetic Surgery Literature

“…4 This leads to significant repercussions and can contribute to racial and ethnic healthcare disparities. [5][6][7] Racial disparities in plastic surgery patient care have been noted for burn injuries, 8 cleft and craniofacial repairs, 9,10 hand injuries, 11 and breast reconstructions. [12][13][14][15] The use of images in medical teaching improves attention, cognition, reflection, and possibly memory retention.…”