A new study reveals that Black Americans are less likely to receive adequate rehabilitation services, including outpatient care and physical therapy, following a traumatic brain injury (TBI) in the United States. This disparity highlights the persistent impact of social determinants of health (SDOH) on access to health care and outcomes, impacting overall health status. The research emphasizes that conditions in which people are born, grow, live, work, and age significantly affect health.
The research, published in the Journal of Head Trauma Rehabilitation, examined the association between SDOH and the receipt of outpatient care for or a home health (HH) rehabilitation visit after hospital discharge among older adults with TBI. The study used a retrospective cohort design, analyzing 100 percent of Texas Medicare claims data from 2014 to 2018. This data provides valuable insight into medical care utilization and disparities in the public health system.
Key Findings
The study found that several contextual-level SDOH factors were associated with decreased utilization of rehabilitation services. These factors include:
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Socioeconomic Position: Areas with high unemployment rates showed decreased utilization of HH services. Additionally, communities with a high percentage of uninsured individuals or a high percentage of rural residents had decreased utilization of outpatient rehabilitation services.
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Residential Context: Individuals living in areas with a greater percentage of residents with severe housing problems were more likely to receive outpatient rehabilitation services.
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Ethno-Racial Identity: Although the study did not identify neighborhood ethno-racial makeup as a significant predictor of rehabilitation services, there was a trend toward older adults living in areas with a higher percentage of Hispanic/Latino residents being associated with a decreased likelihood of receiving HH care.
Disparities Affecting Black Americans
While the study did not find a statistically significant association between neighborhood ethno-racial makeup and rehabilitation services, it did reveal some important trends for Black Americans:
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Decreased Likelihood of Outpatient Rehabilitation: The study found that older patients in areas with greater percentages of Black/African American populations tended to be less likely to receive outpatient rehabilitation. This disparity is consistent with previous research.
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Increased Likelihood of Home Health Care: Older patients in areas with greater percentages of Black/African American populations tended to be more likely to receive HH care.
These findings suggest that Black Americans may face systemic barriers to accessing outpatient rehabilitation services, potentially leading to disparities in care and outcomes.
Social Determinants of Health
The study highlights the critical role of SDOH in shaping healthcare access and utilization. SDOH are the conditions in which people are born, grow, live, work, and age. They include factors such as socioeconomic status, access to healthcare, education, and neighborhood environment.
In this study, several contextual-level SDOH factors were associated with decreased utilization of community-based rehabilitation services. These findings underscore the need to address the social and economic factors that contribute to health disparities.
Implications and Future Directions
The study’s findings have important implications for policy and practice. To address the disparities in access to rehabilitation services, targeted interventions are needed, especially for Black communities. Healthcare systems should consider the disparities in access between HH and outpatient services across different communities.
Future research should continue to explore the link between clinical risk factors, provider practice patterns, and contextual determinants of health. It should also examine how policy and cost changes may impact clinician practices and access to community-based rehabilitation services following TBI.
Final Notes
This study provides further evidence of the disparities in access to community-based rehabilitation services following TBI. Black Americans are disproportionately affected by these disparities, highlighting the need for targeted interventions to improve access to care and promote health equity. By addressing the social determinants of health and implementing culturally sensitive interventions, we can work towards ensuring that all individuals receive the care they need to recover from TBI.