Abstract WMP28: Ethnic Differences In Use Of Rehabilitation In The First 90 Days Following Incident Stroke

Abstract

Introduction: Mexican Americans (MAs) have worse stroke outcomes than non-Hispanic whites (NHWs). One possible explanation is that MAs receive less intense rehabilitation than NHWs. Our objective was to examine ethnic differences in use and type of rehabilitation in the first 90-days following stroke. Methods: Stroke cases were identified from the population-based Brain Attack Surveillance in Corpus Christi Project from Oct 2019-Oct 2021 and followed for 90 days for self-reported use of post-acute rehabilitation care. Sociodemographics, risk factors, stroke severity and treatment were ascertained from interviews and medical records. Functional outcome and depression were assessed at 90 days. Propensity score (PS) methods were used to balance characteristics by ethnicity and PS scores and other covariates were included in a logistic regression model of the association between ethnicity and the primary outcome of use of any rehabilitation. Results: Five hundred fifty-four stroke patients were included, with 66% MA and 49% women. MAs were younger, had lower education and income, worse pre-stroke function, more comorbidities, greater average BMI and worse functional outcome and depression at 90-days than NHWs. One-third of participants did not receive any rehabilitation. MAs (66.9%) were more likely to use any rehabilitation following stroke than NHWs (55.9%; p-value=0.01). After adjustment, MAs were 1.9 times (95% CI: 1.2-2.9) more likely to use any rehabilitation than NHWs. MAs were more likely to use outpatient (11.3% vs 4.8%) and home health rehabilitation (38.0% vs 29.8%) than NHWs, while no differences were noted in use of rehabilitation in inpatient or skilled nursing facilities. Conclusion: A high proportion of stroke survivors report no rehabilitation in the first 90 days following stroke. MAs report greater use of less intense forms of rehabilitation than NHWs despite worse outcomes. Future research should investigate barriers to use of more intense rehabilitation care, particularly in MAs, with the goal of maximizing recovery and reducing ethnic disparities.