Abstract WP86: Racial Disparities In Post-acute Service Utilization In The United States After Intracerebral Hemorrhage

Abstract

Introduction: Intracerebral hemorrhage is a leading cause of long-term disability. Survivors often require significant post-acute care to enhance recovery and decrease disability. Racial/ethnic disparities in hospital discharge destinations can affect patient outcomes and population health. Methods: Data were obtained from the 2017 and 2018 National Inpatient Sample from the Healthcare Cost and Utilization Project. Patients with intracerebral hemorrhage who were admitted directly from the emergency department were included. Discharge destinations were classified as: Home/Routine (home without home health care); Home Health Care (HHC); and Facility (inpatient rehabilitation or skilled nursing facility). Survey-weighted binomial and multinomial logistic regressions were used to examine associations of race/ethnicity with discharge to one pathway versus others, adjusting for age, sex, neighborhood income, insurance status, comorbidities, proxies of stroke severity, and hospital characteristics. Results: The study included 91435 weighted admissions for intracerebral hemorrhage with a racial distribution of 59.7% Whites, 20.9% Hispanics, 21.4% Asian/Pacific Islanders, and 19.7% Blacks. In-hospital mortality was 22.9%, while 18.1% of patients were discharged to Home/Routine, 9.7% to HHC, and 45.1% to a Facility. Hispanics were most likely to be discharged to Home/Routine (24.0%) and least likely to be discharged to a facility (38.7%). Compared to non-Hispanic Whites, other race-ethnic groups had lower odds of being discharged to a facility over home with or without homecare services with the lowest odds amongst Hispanics (adjusted OR, 0.72; 95% CI, 0.70-0.73), followed by Asians/Pacific Islanders (adjusted OR, 0.76, 95% CI, 0.73-0.78), and Blacks (adjusted OR, 0.95; 95% CI, 0.94-0.97). Conclusion: Patients of non-white race-ethnicity admitted with intracerebral hemorrhage are less likely to be discharged to a facility (inpatient rehabilitation or skilled nursing facility) than their white counterparts. The lowest rate of facility discharge was seen among Hispanics. Whether lower formal post-acute service utilization result in worse post-stroke outcomes requires further studies.