Greater healthcare utilization and costs among Black persons compared to White persons with aphasia in the North Carolina stroke belt

• Published in: Journal of the neurological sciences Vol. 376; pp. 76 - 83
• Main Authors: Ellis, Charles, Hardy, Rose Y, Lindrooth, Richard C
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15-05-2017
• Subjects: Adult; African Americans; Aged; Aged, 80 and over; Aphasia; Aphasia - economics; Aphasia - ethnology; Aphasia - etiology; Aphasia - therapy; Disparities; European Continental Ancestry Group; Female; Health Care Costs; Healthcare Disparities - economics; Healthcare Disparities - ethnology; Humans; Length of Stay - economics; Linear Models; Longitudinal Studies; Male; Middle Aged; Neurology; North Carolina; Patient Acceptance of Health Care - ethnology; Stroke; Stroke - complications; Stroke - economics; Stroke - ethnology; Stroke - therapy; Stroke Rehabilitation - economics; Young Adult; Aphasia; Stroke; Disparities
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2017.02.062

Abstract Purpose To examine racial differences in healthcare utilization and costs for persons with aphasia (PWA) being treated in acute care hospitals in North Carolina (NC). Methods NC Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) data from 2011–2012 were analyzed to examine healthcare utilization and costs of care for stroke patients with aphasia. Analyses emphasized length of stay, charges and cost of general hospital services. Generalized linear models (GLM) were constructed to determine the impact of demographic characteristics, stroke severity, and observed hospital characteristics on utilization and costs. Hospital fixed effects were included to yield within-hospital estimates of disparities. Results GLM models demonstrated that Blacks with aphasia experienced 1.9 days longer lengths of stay compared to Whites after controlling for demographic characteristics, 1.4 days controlling for stroke/illness severity, 1.2 days controlling for observed hospital characteristics, and ~ 1 extra day controlling for unobserved hospital characteristics. Similarly, Blacks accrued ~$2047 greater total costs compared to Whites after controlling for demographic characteristics, $1659 controlling for stroke/illness severity, $1338 controlling for observed hospital characteristics, and ~$1311 greater total costs after controlling for unobserved hospital characteristics. Conclusions In the acute hospital setting, Blacks with aphasia utilize greater hospital services during longer hospitalizations and at substantially higher costs in the state of NC. A substantial portion of the adjusted difference was related to the hospital treating the patient. However, even after controlling for the hospital, the differences remained clinically and statistically significant.