Racial Disparities in Discharge Services Persist for Older Adults With Traumatic Brain Injury

Elderly trauma patients are at high risk for requiring postdischarge services such as home health, skilled nursing, or inpatient rehabilitation. This study aimed to identify racial and ethnic disparities in postdischarge services among elderly traumatic brain injury (TBI) patients in the United States.

We conducted a retrospective cross-sectional study using data from the US Trauma Quality Programs (2011-2021), including Medicare patients aged ≥65 with head Abbreviated Injury Score ≥3 who survived to discharge. Patients were categorized by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, and non-Hispanic Asian) and propensity score-matched by age, sex, Charlson Comorbidity Index, and Injury Severity Score. Discharge destinations were ranked by service intensity: home, home with home health, skilled nursing facility, and inpatient rehabilitation. Ordered logistic regression estimated the odds of receiving higher-level discharge services compared with White patients.

Among 339,481 patients (mean age 77.9 ± 6.9 y; 52.2% female; mean Injury Severity Score 14 [interquartile range 10-18]), 86.1% were non-Hispanic White. After matching, non-Hispanic Black patients had higher odds of receiving more intensive discharge services (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.03-1.09). In contrast, Hispanic (OR 0.78, 95% CI 0.76-0.80) and non-Hispanic Asian (OR 0.87, 95% CI 0.84-0.90) patients had lower odds compared to White patients.

Despite adjustment for demographic and clinical factors, Hispanic and non-Hispanic Asian elderly TBI patients were less likely to receive higher-level postdischarge services than their White counterparts. Culturally responsive discharge planning and equitable postacute care pathways are needed to reduce these disparities and improve recovery outcomes for all elderly TBI patients.