Faculty Collaboration Database

Racial/Ethnic Disparities in VA Services Utilization as a Partial Pathway to Mortality Differentials Among Veterans Diagnosed With TBI. Glob J Health Sci 2015 Jul 19;8(2):260-72

Date

09/19/2015

Pubmed ID

26383194

Pubmed Central ID

PMC4803961

DOI

10.5539/gjhs.v8n2p260

Scopus ID

2-s2.0-85021858102 (requires institutional sign-in at Scopus site)   13 Citations

Abstract

OBJECTIVE: Primary: To examine Veterans Administration (VA) utilization and other potential mediators between racial/ethnic differentials and mortality in veterans diagnosed with traumatic brain injury (TBI).

DESIGN: A national cohort of veterans clinically diagnosed with TBI in 2006 was followed from January 1, 2006 through December 31, 2009 or until date of death. Utilization was tracked for 12 months. Differences in survival and potential mediators by race were examined via K-Wallis and chi-square tests. Potential mediation of utilization in the association between mortality and race/ethnicity was studied by fitting Cox models with and without adjustment for demographics and co-morbidities. Poisson regression was used to study the association of race/ethnicity with utilization of specialty services potentially important in the management of TBI.

SETTING: United States (US) Veterans Administration (VA) Hospitals and Clinics.

PARTICIPANTS: 14,690 US veterans clinically diagnosed with TBI in 2006.

INTERVENTIONS: Not Applicable. The study is a secondary data analysis.

MAIN OUTCOME MEASURES: Mortality, Utilization.

RESULTS: Hispanic veterans were found to have significantly higher unadjusted mortality (6.69%) than Non-Hispanic White veterans (2.93%). Hispanic veterans relative to Non-Hispanic White were found to have significantly lower utilization of all services examined, except imaging. Neurology was found to be the utilization mediator with the highest percent of excess risk (3.40%) while age was the non utilization confounder with the highest percent of excess risk (31.49%). In fully adjusted models for demographics and co-morbidities, Hispanic veterans relative to Non-Hispanic Whites were found to have less total visits (IRR 0.89), TBI clinic (IRR 0.43), neurology (IRR 0.35), rehabilitation (IRR 0.37), and other visits (IRR 0.85) with only higher mental health visits (IRR 1.53).

CONCLUSIONS: We found evidence that utilization is a partial mediator between race/ethnicity and mortality, especially neurology utilization. We also found that Hispanic veterans receive significantly less TBI clinic, neurology, rehabilitation and other types of utilization. The use of innovative system factors (decision aids, information tools, patient activation, and adherence support interventions) could be valuable in enhancing utilization of specific TBI related services, especially among ethnic minorities.

Author List

Dismuke CE, Gebregziabher M, Egede LE

Author

Leonard E. Egede MD Center Director, Chief, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Brain Injuries
Female
Humans
Male
Middle Aged
Risk Factors
United States
United States Department of Veterans Affairs
Utilization Review
Veterans