Disparities in Health Care Utilization of Adults With Traumatic Brain Injuries Are Related to Insurance, Race, and Ethnicity: A Systematic Review.
Shiyao Gao, Raj G Kumar, Stephen R Wisniewski and 1 others
PMID 28926481WHAT IT FOUND
Lack of insurance consistently reduced use of hospital and rehabilitation services for adults with traumatic brain injury.
Racial disparities in service use were inconsistent and often disappeared after adjusting for insurance status.
Key findings
01Most articles reported that lack of insurance was strongly associated with decreased use of in-hospital and post-hospital health services.
02Results were inconsistent about whether racial/ethnic minorities were less likely to utilize in-hospital or post-hospital health care services.
03Crude racial/ethnic disparities in health care utilization disappeared after adjusting for insurance status in some reports.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
All included studies used retrospective cohort designs, which cannot prove causation. The review only included articles published in English and focused on US populations, limiting generalizability. Definitions of health care utilization varied across studies, making direct comparison difficult. Some studies did not adjust for key confounders like severity of illness or comorbidities.
The easy way to misread this
Do not conclude that race alone drives disparities in care. The review found that racial disparities often disappeared after adjusting for insurance status, suggesting that insurance coverage is the primary barrier to service utilization.