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

Jaclyn N Portelli Tremont¹, Charlotte B Smith², Rachel Niehuus¹

¹Division of Trauma and Acute Care Surgery, Department of Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.

The Journal of Surgical Research

|July 11, 2026

Summary

Elderly traumatic brain injury (TBI) patients from Hispanic and Asian backgrounds were less likely to receive intensive post-discharge care. This highlights disparities in post-acute services for older adults after TBI.

Keywords:

Discharge disposition Elderly trauma Health equity Postacute care Postdischarge service Traumatic brain injury

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Area of Science:

Trauma Surgery
Geriatrics
Health Services Research

Background:

Elderly trauma patients frequently require post-discharge services like home health, skilled nursing, or inpatient rehabilitation.
Traumatic brain injury (TBI) in older adults presents unique challenges for recovery and post-acute care needs.

Purpose of the Study:

To investigate racial and ethnic disparities in post-discharge service utilization among elderly patients with TBI in the United States.
To identify specific racial and ethnic groups at higher risk for receiving lower levels of post-acute care after TBI.

Main Methods:

Retrospective cross-sectional study utilizing US Trauma Quality Programs data (2011-2021).
Inclusion of Medicare patients aged 65+ with severe head injury (Abbreviated Injury Score ≥3) surviving to discharge.
Propensity score matching to control for demographic and clinical confounders; analysis of discharge destinations ranked by service intensity.

Main Results:

Analysis included 339,481 elderly TBI patients; 86.1% were non-Hispanic White.
Non-Hispanic Black patients showed higher odds of receiving more intensive discharge services (OR 1.06).
Hispanic (OR 0.78) and non-Hispanic Asian (OR 0.87) patients had significantly lower odds of receiving higher-level services compared to White patients.

Conclusions:

Significant racial and ethnic disparities persist in post-discharge service allocation for elderly TBI patients, even after adjusting for key factors.
Hispanic and non-Hispanic Asian elderly TBI survivors are less likely to access intensive post-acute care compared to their White counterparts.
Culturally sensitive discharge planning and equitable care pathways are crucial to mitigate disparities and enhance recovery for all elderly TBI patients.