By Saumya Joseph
(Reuters Health) - When people with moderate or severe injuries are discharged from the hospital, follow-up care, especially at rehabilitation centers, is a crucial part of their recovery - but African Americans are less likely than white patients to seek out or receive these important services, a U.S. study suggests.
"The results are important in that they highlight yet another disparity that exists in this vulnerable patient population," study coauthor Dr. George Kasotakis from Duke University School of Medicine in Durham, North Carolina, told Reuters Health by email.
Kasotakis and colleagues analyzed data from three trauma centers in Boston on 182 black and 1,117 white patients who were injured between December 2015 and July 2018.
When contacted between six and 12 months after they'd left the hospital, only 64.3 percent of the black patients said they had sought rehab services after discharge, compared to 79.8 percent of white patients. Similarly, only 40.0 percent of African-Americans went to doctors' offices or clinics for injury-related visits, compared to 47.0 percent of whites.
African-Americans, however, were more likely than white patients to go back to emergency rooms for problems related to their injuries.
The pattern was similar when the research team compared two matched subsets: 141 black and 628 white patients who were similar in age, gender, insurance status and injury type. Compared to white patients, African-Americans were 36 percent less likely to use rehabilitation services, and they had 41 percent fewer outpatient visits.
Traumatic injuries can result in reduced quality of life, chronic pain, psychological disturbances and the burden of high medical costs, the study authors note in the American Journal of Surgery.
Rehabilitation services have been found to improve long-term outcomes and functional independence after injury.
Independent of socioeconomic status, African American trauma patients have been found in previous studies to have a higher mortality rate and a higher likelihood of long-term disability compared to white patients, the researchers write.
Prior studies have also shown that injured African American patients are more likely to be sent home when they leave the hospital, rather than being sent to rehab centers or skilled nursing facilities, the researchers note.
Dr. Anthony Fabio, an assistant professor of epidemiology at the University of Pittsburgh who wasn't involved in the current study, pointed out that it doesn't address whether affluent African Americans are more or less likely to receive rehabilitation services than their low-income counterparts.
"Being black isn't the issue," Fabio said in a phone interview. "The issue is probably that there's institutionalized racism in the United States and if you're African American you're more likely to be born in a poor neighborhood, which has a whole plethora of disadvantages as you grow up and move through life."
Patients' understanding of the importance of follow-up care, access to rehab services and distrust of medical providers could be contributing to the disparities, the researchers write.
Having doctors engage in more active conversations with patients on the benefits of post-injury care and setting up systems providing resources such as transportation to make it easier to access rehab centers could help, Fabio said.
The experts admit it will be difficult to resolve the disparity, given the innate issues at play.
"How can you address lower education, lower pay, lack of quality insurance across the board?" said Kasotakis, noting that expanding mandatory insurance has helped close the gaps to a certain extent.
SOURCE: https://bit.ly/2PhmYlr The American Journal of Surgery, online April 1, 2019.