Ethnic Differences In Access Research Articles

Racial and ethnic differences in access to care and treatment in patients with suspected acute stroke: A retrospective, observational, cohort study

BackgroundData regarding unequal diagnostic and therapeutic access in patients with acute stroke based on ethnicity and race are inconclusive in Europeans. The objectives of our study were to evaluate the effect of race/ethnicity on access to acute stroke care and treatments and outcomes. MethodsIn this retrospective cohort study, we enrolled adult patients admitted to the emergency department of a comprehensive stroke center for suspected stroke. Based on race/ethnicity, patients were divided into two main groups: Western European Whites (WEW) and non-Western European Whites (nWEW). We also divided the nWEW group into four subgroups based on the Office of Management and Budget classification of human races and ethnicities (White-Others, Hispanic, Asian, Black). Univariate comparisons and logistic regression analyses were also performed. Results9167 patients were enrolled in the study: 582 in the nWEW and 8585 in the WEW group. Patients with ischemic stroke in the nWEW group were significantly younger than those in the other group (p < 0.001). Once adjusted for possible confounders, belonging to the nWEW group was found to be an independent predictor of a lower likelihood of receiving revascularization treatments (p = 0.006), regardless similar onset-to-door times. There were no differences in stroke outcomes and prevalence of stroke mimic diagnosis between the groups. ConclusionsRacial/ethnic disparities in healthcare represent a challenging issue, even in universal healthcare systems, that should be addressed promptly through education campaigns of healthcare personnel and implementation measures, such as integrating readily available interpreter staff for medical emergencies.

Increasing access to legal information with unsupervised solutions

AbstractAccess to justice is a significant area of legal research, especially for Socio-Legal studies. The main research topics of this area are economic or class differences, gender inequalities, or national and ethnic differences in access to justice. However, there is a less discussed aspect of access to justice: the differences between access to legal information and the differences in user groups in terms of comprehending and processing legal information. This is an important topic because there are significant differences among people's abilities to process and understand legal texts, depending on whether we are dealing with a lawyer who is an expert in the given field, a non-expert lawyer, or a citizen with a low or zero (legal) educational level. The paper argues that unsupervised machine learning solutions can help even out these differences. It presents different unsupervised solutions, mainly clustering and topic modelling, which can help to increase access to legal information. Then we present a case study in which we examine these unsupervised tools in the processing of resolutions of the Central Bank in Hungary and anonymized court decisions. The paper argues that these tools can reveal the hidden contextual regularities in unstructured legal texts, facilitating the search for legal texts even for non-legal-experts.

Baseline Racial and Ethnic Differences in Access to Transplantation in Medicare’s ESRD Treatment Choices Payment Model

Baseline Racial and Ethnic Differences in Access to Transplantation in Medicare’s ESRD Treatment Choices Payment Model

Healthcare Access for a Diverse Population with Schizophrenia Following the Onset of the COVID-19 Pandemic

COVID-19 has had a disproportionate impact on the most disadvantaged members of society, including minorities and those with disabling chronic illnesses such as schizophrenia. We examined the pandemic’s impacts among New York State’s Medicaid beneficiaries with schizophrenia in the immediate post-pandemic surge period, with a focus on equity of access to critical healthcare. We compared changes in utilization of key behavioral health outpatient services and inpatient services for life-threatening conditions between the pre-pandemic and surge periods for White and non-White beneficiaries. We found racial and ethnic differences across all outcomes, with most differences stable over time. The exception was pneumonia admissions—while no differences existed in the pre-pandemic period, Black and Latinx beneficiaries were less likely than Whites to be hospitalized in the surge period despite minorities’ heavier COVID-19 disease burden. The emergence of racial and ethnic differences in access to scarce life-preserving healthcare may hold lessons for future crises.

Editor’s Choice Articles for April

Editor’s Choice Articles for April

Access, retention, and effectiveness of Individual Placement and Support in the U.S.: Are there racial or ethnic differences?

BACKGROUND: Increased federal attention to advancing racial equity and support for underserved communities suggests the need for data on racial and ethnic differences in evidence-based employment services for people with serious mental illness. Individual Placement and Support (IPS) is an evidence-based model of supported employment for this population. OBJECTIVE: The objective was to identify differences based on race and ethnicity in IPS services. METHODS: This narrative review examined the empirical literature on IPS services in the U.S., assessing evidence of differences in access, retention, and effectiveness for Black and Hispanic IPS clients, relative to non-Hispanic Whites. RESULTS: We identified 12 studies examining racial and ethnic differences in access (4 studies), retention (3 studies), and effectiveness (6 studies). The findings for access to IPS were mixed, with two studies showing no differences, one finding less access for Blacks, and another finding greater access for Blacks but less access for Hispanics. Three studies found better retention rates for clients enrolled in IPS regardless of race or ethnicity. Compared to clients receiving usual vocational services, all studies found better employment outcomes for IPS clients regardless of race or ethnicity. CONCLUSION: Unlike for most of health care, few racial and ethnic differences have been found for IPS employment services in the U.S. Access to IPS is inadequate for all groups, with conflicting evidence whether Blacks and Hispanics have even less access. Based on the available evidence, Black and Hispanic clients have comparable retention and employment outcomes in IPS as non-Hispanic White clients. State and local mental health leaders responsible for monitoring IPS outcomes should routinely report statistics on race and ethnicity. They should also give active attention to client needs and equity. Research designs should answer multifaceted questions regarding disparities for historically underserved populations.

A Health Equity Study on Access by Ethnicity to Fecal Immunochemical Testing for Colorectal Cancer Screening at a Veteran Affairs Medical Center

Abstract Introduction/Objective It has been documented in the literature that significant ethnic and racial disparities in access to healthcare exist. Additionally, it has also been shown that these disparities can be corrected. Integrated health care systems such as the Veterans’ Administration health care system have previously been demonstrated to lead to more equitable care delivery and improved outcomes with lower racial and ethnic differences in access to care. Standard of care guidelines issued by the U.S. Preventive Services Task Force (USPSTF) exist recommending screening for colorectal cancer in adults, of which one of the screening methods involves the convenient fecal immunochemical test (FIT). FIT is a noninvasive simple screening test compared to alternatives such as colonoscopy. Given FIT’s benefits, the authors explored the accessibility by ethnicity for this important test at a Veteran Affairs Medical Center (VAMC). Methods/Case Report A search of all FIT testing performed at a regional VAMC from 10/1/2018 to 6/4/2022 was performed to determine the patient demographics including age, gender, and ethnicity. The ethnic distribution of all tested patients was compared to the local census population demographics of the county (Philadelphia) in which the VAMC is located (updated July 1, 2021). Results (if a Case Study enter NA) There were a total of 10,110 FIT tests conducted during the study period. From these 10,110 FIT tests, the ethnic composition of the test population is as follows: 5,164 or 51% (5,164/10,110) were African American, 4,389 or 43% (4,389/10,110) were Caucasian American, 65 or 0.6% (65/10,110) were Asian American, 48 or 0.5% were American Indian or Alaska Native American, 111 or 1% (111/10,110) were Native Hawaiian or other Pacific Islander Americans, and 333 or 3.2% (333/10,110) were unknown or declined to state in the medical record. Per the local county census, 44.8% of the local population was Caucasian American and 43.6% were African American. Conclusion The VAMC, being an integrated health care system, provides equitable access to FIT to screen for colorectal cancer.

Mortality outcomes and inequities experienced by rural Māori in Aotearoa New Zealand

SummaryBackgroundPrevious research identified inequities in all-cause mortality between Māori and non-Māori populations. Unlike comparable jurisdictions, mortality rates in rural areas have not been shown to be higher than those in urban areas for either population. This paper uses contemporary mortality data to examine Māori and non-Māori mortality rates in rural and urban areas.MethodsA population-level observational study using deidentified routinely collected all-cause mortality, amenable mortality and census data. For each level of the Geographic Classification for Health (GCH), Māori and non-Māori age-sex standardised all-cause mortality and amenable mortality incident rates, Māori:Non-Māori standardised incident rate ratios and Māori rural:urban standardised incident rate ratios were calculated. Age and deprivation stratified rates and rate ratios were also calculated.FindingsCompared to non-Māori, Māori experience excess all-cause (SIRR 1.87 urban; 1.95 rural) and amenable mortality (SIRR 2.45 urban; 2.34 rural) and in all five levels of the GCH. Rural Māori experience greater all-cause (SIRR 1.07) and amenable (SIRR 1.13) mortality than their urban peers. Māori and non-Māori all-cause and amenable mortality rates increased as rurality increased.InterpretationThe excess Māori all-cause mortality across the rural: urban spectrum is consistent with existing literature documenting other Māori health inequities. A similar but more pronounced pattern of inequities is observed for amenable mortality that reflects ethnic differences in access to, and quality of, health care. The excess all-cause and amenable mortality experienced by rural Māori, compared to their urban counterparts, suggests that there are additional challenges associated with living rurally.FundingThis work was funded by the Health Research Council of New Zealand (HRC19/488).

Explaining Ethnic Differences in Access to VET in German-Speaking Switzerland: the Effects of Application Behavior and Resources

Abstract The aim of this paper is to explain ethnic differences in the transition from school to vocational education and training (VET) in German-speaking Switzerland. I examine the impact of application behavior and resource endowment on access to VET and the number of applications submitted. Even after controlling for differences in resource endowment, I find clear ethnic penalties in success rates and the number of applications submitted between natives and minority students. Once I introduce different application behavior in my models, ethnic differences in success rates either diminish sharply or even vanish. However, substantial ethnic penalties remain in the number of applications submitted. There are therefore indications of discrimination in the application process on the Swiss–German VET market.

Racial and Ethnic Differences in Hospital Admissions of Emergency Department COVID-19 Patients.

Background:Several studies have found that among patients testing positive for COVID-19 within a health care system, non-Hispanic Black and Hispanic patients are more likely than non-Hispanic White patients to be hospitalized. However, previous studies have looked at odds of being admitted using all positive tests in the system and not only those seeking care in the emergency department (ED).Objective:This study examined racial/ethnic differences in COVID-19 hospitalizations and intensive care unit (ICU) admissions among patients seeking care for COVID-19 in the ED.Research Design:Electronic health records (n=7549) were collected from COVID-19 confirmed patients that visited an ED of an urban health care system in the Chicago area between March 2020 and February 2021.Results:After adjusting for possible confounders, White patients had 2.2 times the odds of being admitted to the hospital and 1.5 times the odds of being admitted to the ICU than Black patients. There were no observed differences between White and Hispanic patients.Conclusions:White patients were more likely than Black patients to be hospitalized after presenting to the ED with COVID-19 and more likely to be admitted directly to the ICU. This finding may be due to racial/ethnic differences in severity of disease upon ED presentation, racial and ethnic differences in access to COVID-19 primary care and/or implicit bias impacting clinical decision-making.

Racial and ethnic patterns and differences in health care expenditures among Medicare beneficiaries with and without cognitive deficits or Alzheimer\u2019s disease and related dementias

BackgroundNumerous studies have documented racial and ethnic differences in the prevalence and incidence of Alzheimer’s disease and related dementias (ADRD). Less is known, however, about racial and ethnic differences in health care expenditures among older adults at risk for ADRD (cognitive deficits without ADRD) or with ADRD. In particular, there is limited evidence that racial and ethnic differences in health care expenditures change over the trajectory of ADRD or differ by types of service.MethodsWe examined racial and ethnic patterns and differences in health care expenditures (total health care expenditures, out-of-pocket expenditures, and six service-specific expenditures) among Medicare beneficiaries without cognitive deficits, those with cognitive deficits without ADRD, and those with ADRD. Using the 1996–2017 Medical Expenditure Panel Survey, we performed multivariable regression models to estimate expenditure differences among racial and ethnic groups without cognitive deficits, those with cognitive deficits without ADRD, and those with ADRD. Models accounted for survey weights and adjusted for various demographic, socioeconomic, and health characteristics.ResultsBlack, Asians, and Latinos without cognitive deficits had lower total health care expenditures than whites without cognitive deficits ($10,236, $9497, $9597, and $11,541, respectively). There were no racial and ethnic differences in total health care expenditures among those with cognitive deficits without ADRD and those with ADRD. Across all three groups, however, Blacks, Asians, and Latinos consistently had lower out-of-pocket expenditures than whites (except for Asians with cognitive deficits without ADRD). Furthermore, service-specific health care expenditures varied by racial and ethnic groups.ConclusionsOur study did not find significant racial and ethnic differences in total health care expenditures among Medicare beneficiaries with cognitive deficits and/or ADRD. However, we documented significant differences in out-of-pocket expenditures and service-specific expenditures. We speculated that the differences may be attributable to racial and ethnic differences in access to care and/or preferences based on family structure and cultural/economic factors. Particularly, heterogeneous patterns of service-specific expenditures by racial and ethnic groups underscore the importance of future research in identifying determinants leading to variations in service-specific expenditures among racial and ethnic groups.

Disparities in Access to Minimally Invasive Hysterectomy in a Suburban Community Hospital: A Patient-Level Analysis

Study Objective Prior studies have identified differences in access to minimally invasive hysterectomy (MIH) based on demographic characteristics. These differences do not always persist when including patient-level information that may affect surgical decision-making. This study aims to identify racial or ethnic differences in access to MIH (laparoscopic or robotic) at our institution, as well as trends in access over time. Design Retrospective cohort study. Setting Suburban community hospital. Patients or Participants All adult women undergoing hysterectomy for benign indications, January 2015– December 2019. Exclusion criteria were a preoperative diagnosis of pelvic malignancy, concurrent sacrocolpopexy, emergent hysterectomy, or vaginal hysterectomy. Interventions N/A Measurements and Main Results A total of 1,632 patients were included in the analysis. 54% were non-Hispanic white, 17% non-Hispanic black, 21% Hispanic of any race, and 8% Asian, Native American, Pacific Islander or self-identified as “other”. Black and Hispanic women were significantly less likely to undergo MIH than white women, OR 0.490 (CI 0.371 – 0.646, p Conclusion This study identified a disparity in likelihood of undergoing MIH for non-white women. This was eliminated for black and “other” women after controlling for patient-level information but persisted in Hispanic women. Further study is warranted to better understand the factors underlying this finding.

Ethnic Differences in Access to Stroke Reperfusion Therapy in Northern New Zealand

Background: In New Zealand, Māori and Pacific people have higher age-adjusted stroke incidence rates, younger age at first stroke, and higher mortality at 12 months than other ethnic groups. We aimed to determine if access to acute stroke reperfusion therapy with intravenous thrombolysis (IVT) or endovascular thrombectomy (EVT) is equitable among ethnic groups. Methods: Data were obtained from the Northern Region component of the New Zealand Stroke Registry over the 21 months between January 1, 2018 and September 30, 2019. Data recorded included demographic details, self-identified ethnicity, treatment times, and clinical outcomes. National hospital discharge coding of patients admitted with ischemic stroke and stroke unspecified was used to determine the proportion of patients treated by ethnic group. Results: There were 537 patients normally resident in the Northern Region who received reperfusion therapy: 281 received IVT alone, 123 received EVT after bridging IVT, and 133 received EVT alone. Of the 537 patients treated with IVT or EVT, there were 81 (15.1%) Māori, 78 (14.5%) Pacific, 57 (10.6%) Asian, and 341 (63.5%) NZ European/other ethnicity patients. There were no ethnic differences in treatment process times. When compared with NZ European/others, Māori and Pacific people were younger, and Māori had worse neurological impairment at admission. A higher proportion of Māori were treated with EVT with a trend to higher proportion treated with IVT. Day 90 modified Rankin Scale (mRS) for EVT-treated patients was similar apart from Asian patients who had worse outcome when compared with NZ European/others (mRS 3 vs. 2; p = 0.03). Conclusions: This study has shown equitable access to acute stroke reperfusion therapies and largely similar outcomes in different ethnic groups in northern New Zealand.

Inequalities and outcomes: end stage kidney disease in ethnic minorities

BackgroundThe international evidence about outcomes of End Stage Kidney Disease (ESKD) for ethnic minorities was reviewed to identify gaps and make recommendations for researchers and policy makers.MethodsNine databases were searched systematically with 112 studies from 14 different countries included and analysed to produce a thematic map of the literature.ResultsReviews (n = 26) highlighted different mortality rates and specific causes between ethnic groups and by stage of kidney disease associated with individual, genetic, social and environmental factors. Primary studies focussing on uptake of treatment modalities (n = 19) found ethnic differences in access. Research evaluating intermediate outcomes and quality of care in different treatment phases (n = 35) e.g. dialysis adequacy, transplant evaluation and immunosuppression showed ethnic minorities were disadvantaged. This is despite a survival paradox for some ethnic minorities on dialysis seen in studies of longer term outcomes (n = 29) e.g. in survival time post-transplant and mortality. There were few studies which focussed on end of life care (n = 3) and ethnicity.Gaps identified were: limited evidence from all stages of the ESKD pathway, particularly end of life care; a lack of system oriented studies with a reliance on national routine datasets which are limited in scope; a dearth of qualitative studies; and a lack studies from many countries with limited cross country comparison and learning.ConclusionsDifferences between ethnic groups occur at various points and in a variety of outcomes throughout the kidney care system. The combination of individual factors and system related variables affect ethnic groups differently indicating a need for culturally intelligent policy informed by research to prevent disadvantage.

Abstract WP280: Sleep Apnea Screening is Uncommon After Stroke

Introduction: Sleep apnea (SA) predicts poor functional outcome and mortality after stroke. Minority populations, including Mexican Americans (MAs), have worse outcomes after stroke than non-Hispanic whites (NHWs) and tend to have poorer access to care. We therefore sought to (1) assess access to SA-related care among post-stroke patients within a population-based study without an academic medical center, and (2) to compare ethnic differences in access to SA-related care in the post-stroke period in MAs and NHWs. Methods: MA and NHWs with ischemic stroke or intracerebral hemorrhage in the Brain Attack Surveillance in Corpus Christi project between 2011-2015 were interviewed at approximately 90 days after stroke in reference to the post-stroke period. Questions included whether their clinical provider directly asked about (1) snoring or (2) daytime sleepiness, or (3) had offered polysomnography. Logistic regression was used to test the association between ethnicity and the three outcomes unadjusted and adjusted for potential confounders: age, sex, insurance status, primary care provider status (PCP), BMI, stroke type, NIHSS at stroke presentation, hypertension, diabetes, atrial fibrillation, hyperlipidemia, and current smoking. Results: Of the almost 1,000 respondents, 49% were male, 63% MA, 81% had hypertension, 48% had diabetes, and 10% did not have a PCP. Mean age was 69 (SD=12) and mean BMI was 30 (SD=6.8). MAs were younger, had a higher BMI, greater prevalence of hypertension, diabetes, never smoking, and lower prevalence of atrial fibrillation than NHWs. Of the 985 respondents to the symptom questions, 50 (5%) reported being directly queried about snoring and 86 (9%) reported being directly queried about sleepiness. Fifty-five of 981 (6%) reported having been offered polysomnography by their providers. No ethnic differences were found among the three outcomes in unadjusted or adjusted analyses. Conclusion: Screening for classic symptoms of SA and offers for formal testing of SA by clinical providers are rare by 90 days post-stroke, without ethnic differences. Provider education is needed to raise awareness about the very high prevalence of SA among stroke patients and its association with poor outcomes after stroke.

Does what you study at age 14–16 matter for educational transitions post-16?

This paper considers whether subject choice at 14–16 influences post-16 transitions, taking into account prior academic attainment and school characteristics, and if so, whether this accounts for socioeconomic, gender, and ethnic differences in access to post-16 education. We consider post-16 progression to full-time education, A-levels, and studying two or more facilitating subjects at A-level. We use ‘Next Steps’, a study of 16,000 people born in England in 1989–1990, linked to administrative education records (the National Pupil Database). We find that students pursuing an EBacc-eligible curriculum at 14–16 had a greater probability of progression to all post-16 educational outcomes, while the reverse was true for students taking an applied GCSE subject. Curriculum differences did not explain the social class differences in post-16 progression, but an academic curriculum was equally valuable for working-class as for middle-class pupils. Pursuing an EBacc-eligible curriculum particularly strongly increased the chances of girls and white young people staying in the educational pipeline, whereas applied subjects were particularly detrimental for girls. An EBacc-eligible curriculum at age 14–16 increased the chances of studying subjects preferred by Russell Group universities at A-level.

The impact of race and ethnicity on mortality and healthcare utilization in alcoholic hepatitis: a cross-sectional study.

BackgroundAlcoholic Hepatitis (AH) is major source of alcohol-related mortality and health care expenditures in the United States. There is insufficient information regarding the role of race and ethnicity on healthcare utilization and outcomes for patients with AH. We aimed to determine whether there are racial/ethnic differences in resource utilization and inpatient mortality in patients hospitalized with AH.MethodsWe analyzed data from the Nationwide Inpatient Sample (NIS), years 2008–2011. We calculated demographic, clinical, and healthcare utilization characteristics by race. We then performed logistic regression and generalized linear modeling with gamma distribution (log link), respectively, to determine predictors of inpatient morality and total hospital costs (THC).ResultsWe identified 11,304 AH patients from 2008 to 2011. Mean age was 47.0 years, and 62.1 % were male, 61.9 % were white, 9.8 % were black, and 9.7 % were Hispanic. Mean LOS was 6.3 days and significantly longer in whites (6.5 d) than both blacks (5.4 d) and Hispanics (5.9 d). In adjusted models, inpatient mortality was lower for blacks than for whites (adj. OR = 0.50; 95 % CI = 0.32–0.78). THC was significantly higher for Hispanics than whites (fold increase = 1.25; 95 % CI = 1.01–1.49).ConclusionsWe identified differences in healthcare utilization and mortality by race/ethnicity. THC was significantly higher among Hispanics than for whites and blacks. We also demonstrated lower inpatient mortality in blacks compared to whites. These variations may implicate racial and ethnic differences in access to care, quality of care, severity of AH on presentation, or other factors.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-016-0544-y) contains supplementary material, which is available to authorized users.

The role of marriage in explaining racial and ethnic disparities in access to health care for men in the US

Reducing disparities in access to health care is a long-standing objective of the federal government. Building on research showing that marriage can provide important resources for obtaining needed health care, we suggest that racial and ethnic differences in marriage could explain persistent disparities in access. Using data from MEPS and NLSY we investigate the association between marriage and access to health care among men, and estimate the extent to which racial and ethnic differences in both the returns to marriage and marital rates explain differences in access and preventive service use. We find that marriage accounts for up to 24 % of racial and ethnic differences in access and preventive use. The returns to marriage for whites and blacks, however, are greater than that for Hispanics. We suggest that differences in spousal characteristics such as education and income could explain why whites and blacks benefit from marriage more than Hispanics. We find support for this hypothesis: differences in spousal characteristics account for up to 37 % of the gap in access and preventive use among married adults.

Neighborhood ethnic density and suicide risk among different migrant groups in the four big cities in the Netherlands.

Recent studies suggested a favorable association between the ethnic density of the neighborhood and the risk of psychotic disorders among ethnic minorities. In this study, it was investigated whether this so-called 'ethnic density hypothesis' is also relevant to suicide risk, which is not sensitive to bias associated with ethnic differences in access to health care and reflects a broad range of mental health problems. Suicides in the four big cities in the Netherlands during 2000-2011 were ascertained using the cause of death register of Statistics Netherlands and analyzed in a multilevel Poisson model in relation to individual- and neighborhood-level characteristics. With increasing non-Western minority density, the adjusted rate ratio (RR) of suicide in non-Western immigrants compared to native Dutch persons decreased from 0.69 to 0.39 (P < 0.001). This was explained by higher suicide rates among Dutch persons (RR = 1.28, P = 0.048) and lower rates among non-Western persons (RR = 0.72, P = 0.004) in neighborhoods with high (>55.9 %) compared to neighborhoods with low non-Western minority density (<36.5 %). Similar results were found for Turkish, Moroccan, Surinamese/Antillean and other non-Western subgroups separately. Compared to personally matched controls, non-Western cases (i.e., those who committed suicide) more often moved house to own-group high-dense areas and less often to own-group low-dense areas in the 5 years prior to suicide. Our findings support the beneficial influence of the presence of the own ethnic group in the neighborhood on suicide risk among non-Western minorities. As moving to minority more dense areas prior to suicide was observed, this influence of ethnic density as measured on population level may have been underestimated.

Abstract T MP45: Ethnic Differences in Access to Post-acute Care Following Stroke: The BASIC Project

Background: Mexican Americans (MAs) have worse post-stroke functional and neurologic outcomes than non-Hispanic whites (NHWs). Ethnic differences in utilization and intensity of post-acute care (PAC) are possible explanations. We tested the hypothesis that MAs have less utilization and less intense PAC than NHWs in a bi-ethnic stroke population. Methods: Stroke patients (n=393) were identified from the BASIC Project (2009-2011). Patients admitted from a nursing home and those discharged to a setting other than home or institutional PAC were excluded. Ethnicity was based on self-report. Utilization of any institutional PAC (inpatient rehabilitation facility (IRF) or skilled nursing facility (SNF)) following hospital discharge was determined from UB-92 claims forms. Intensity of rehabilitation was explored by comparing utilization of IRF versus SNF among those receiving PAC. Hierarchical logistic regression models to account for clustering of patients within hospitals were used to determine the associations between ethnicity and utilization and intensity of PAC. Models were run unadjusted and adjusted for demographics (age, sex), socioeconomic status (insurance, education), clinical stroke factors (NIHSS, stroke type), and pre-stroke factors (comorbidity index, pre-stroke function, pre-stroke cognition). Results: Sixty-three percent were MA (n=249); 49% (n=194) were women. Median age was 66 (IQR: 57-78); median NIHSS was 4 (IQR: 2-8). Among MAs, 64% were discharged to home, 21% to a SNF and 15% to an IRF. Among NHWs, 53% were discharged to home, 26% to a SNF, and 22% to an IRF. In the unadjusted model MAs were 39% (OR=0.61; 95% CI: 0.39, 0.94) less likely to utilize institutional PAC than NHWs. After adjustment, MAs were 41% (OR=0.59; 95% CI: 0.32, 1.09) less likely to utilize institutional PAC than NHWs. Among those who utilized PAC there were no ethnic differences in intensity (IRF vs SNF) in unadjusted (p=0.36) or adjusted (p=0.63) analyses. Conclusion: We found a trend towards MAs having less utilization of PAC than NHWs following stroke. Additional research with more refined measures of PAC is needed to understand the role that access to, and effectiveness of, rehabilitative services play in ethnic differences in post-stroke outcomes.