Race, ethnicity, and utilization of outpatient rehabilitation for treatment of post COVID-19 condition. PM R 2022 Nov;14(11):1315-1324
Date
07/06/2022Pubmed ID
35789541Pubmed Central ID
PMC9350262DOI
10.1002/pmrj.12869Scopus ID
2-s2.0-85137046427 (requires institutional sign-in at Scopus site) 7 CitationsAbstract
INTRODUCTION: Outpatient rehabilitation is recommended in the treatment of post coronavirus disease 2019 (COVID-19) condition. Although racial and ethnic disparities in the incidence and severity of COVID-19 have been well documented, little is known about the use of outpatient rehabilitation among patients with post COVID-19 condition.
OBJECTIVE: To examine factors associated with outpatient rehabilitation use following COVID-19 and to ascertain whether differential incidence of sequelae explain variation in post COVID-19 rehabilitation utilization by race and ethnicity.
DESIGN: Case-control study.
SETTING: Community.
PARTICIPANTS: U.S. adults with COVID-19 during 2020 in the TriNetX database.
INTERVENTION: N/A.
MAIN OUTCOME MEASURES: Receipt of outpatient rehabilitation services within 6 months of COVID-19 diagnosis and incidence of post COVID-19 condition symptoms (weakness, fatigue, pain, cognitive impairment, mobility difficulties, and dyspnea).
RESULTS: From 406,630 laboratory-confirmed COVID-19 cases, we identified 8724 individuals who received outpatient rehabilitation and matched 28,719 controls. Of rehabilitation users, 43.3% were 40 years old or younger, 54.8% were female, 58.2% were White, 17.9% were African American/Black, 2.1% were Asian, 13.0% were Hispanic, 39.2% had no comorbidities, and 40.3% had been hospitalized for COVID-19. Dyspnea (20.4%), fatigue (12.4%), and weakness (8.2%) were the most frequently identified symptoms. Although there were no racial differences in the incidence of the six post COVID-19 condition symptoms considered, African American/Black individuals were significantly less likely than their White counterparts to receive outpatient rehabilitation (odds ratio [OR] = 0.89; 95% confidence interval [CI]: 0.84-0.96; p = .003). Hispanic individuals had higher outpatient rehabilitation utilization (OR = 1.22; 95% CI: 1.11-1.33; p < .001) and a significantly higher incidence of post COVID-19 fatigue.
CONCLUSIONS: In this large nationally representative study, African American/Black race was associated with lower utilization of outpatient rehabilitation services despite a similar incidence of post COVID-19 condition symptoms. Further research is needed to better understand access barriers to rehabilitation services for post COVID-19 condition recovery care and address racial inequalities in receipt of care.
Author List
Hentschel CB, Abramoff BA, Dillingham TR, Pezzin LEAuthor
Liliana Pezzin PhD, JD Professor in the Institute for Health and Equity department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultCase-Control Studies
Dyspnea
Fatigue
Female
Humans
Male
Outpatients
United States
