Racial/Ethnic Disparities in Poststroke Outpatient Rehabilitation Among Veterans

Abstract

To examine racial/ethnic differences in the use of poststroke outpatient rehabilitation in veterans. We examined data from 4115 veterans with a diagnosis of stroke who were seen at a VA Medical Center in the southeastern United States. We compared the receipt of physical therapy (PT) and occupational therapy (OT) evaluations, visits, and procedures among 3 racial/ethnic groups. Multiple logistic regression was used to assess the independent effect of race/ethnicity on the receipt of a PT or OT evaluation and Poisson regression to estimate the effect of race/ethnicity on treatment visits and procedures received. In univariate comparisons, a higher proportion of blacks received PT and OT evaluations than whites and others. Similarly, blacks received a higher mean number of PT/ OT treatments than whites and others. In multivariate logistic models with whites as reference, blacks were more likely to receive PT evaluations (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.24-1.74) and OT evaluations (OR, 1.23; 95% CI, 1.01-1.51). In multivariate Poisson models with whites as reference, blacks received more PT/OT visits (OR, 7.22; 95% CI, 5.95-8.76) than non-Hispanic whites (OR, 5.28; 95% CI, 4.41-6.33), while others received fewer visits (OR, 4.39; 95% CI, 3.58-5.39) than the reference group. No significant differences were observed across groups in the number of procedures completed during each treatment visit. In an equal-access system, blacks were more likely to receive outpatient PT/OT evaluations and higher mean number of PT/OT treatments. Future studies need to examine sociodemographic and disease-specific factors that account for these differences.