Original researchUrban-Rural Differences in Service Utilization and Costs of Care for Racial-Ethnic Groups Hospitalized With Poststroke Aphasia
Section snippets
Study Perspective and Approach
The purpose of this study was to examine the influence of rural or urban residence on health care service utilization (general medical and SLP) and costs in hospitalized PWA. Two previous studies have shown that black PWA are more likely to have greater hospital service utilization and at a higher cost than white PWA.10, 11 Yet neither explored the potential for double disadvantage (race-ethnicity and rural/urban residence) in relation to service utilization patterns and costs in PWA.
Methods
This study was reviewed and approved by the East Carolina University Institutional Review Board. Data for this study were obtained from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project (HCUP) State Inpatient Database from the state of North Carolina.18 The HCUP database includes discharge data from all acute care licensed hospitals located in North Carolina. This analysis used 2011 and 2012 discharge data for PWA.
To identify PWA with ischemic stroke,
Results
There were 4381 individuals identified with poststroke aphasia in North Carolina between 2011 and 2012. Seventy percent were age 65 or older, 55% were women, and Medicare was the primary insurance type in almost two-thirds of the sample. Approximately 50% of the sample experienced a stroke that was considered mild, and ∼40% experienced a stroke that was considered severe. Rural PWA were more likely to have Medicare, less likely to have private insurance, and more likely to be transferred to a
Discussion
The findings of this study suggest that in the acute care setting, race-ethnicity is a more salient contributor to overall health care utilization and costs than residence among PWA. Both rural and urban black PWA experienced a longer LOS with higher associated costs than their white counterparts. Similarly, black PWA living in both rural and urban areas used more SLP services than white PWA living in rural and urban areas. Yet, the observed differences in LOS and costs between white and black
Conclusions
The findings reported here suggest that race-ethnicity influences economic outcomes of PWA treatment. Observed differences were not because of traditional explanations regarding greater stroke severity among blacks. The influence of race-ethnicity on outcomes was in part related to which hospital admitted the patient rather than differences in treatment within a hospital. Because aphasia rehabilitation occurs at all stages of poststroke care, future studies should examine rural-urban and
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The Excess Costs of Hospitalization for Acute Stroke in People With Communication Impairment: A Stroke123 Data Linkage Substudy
2023, Archives of Physical Medicine and RehabilitationAphasia severity is modulated by race and lesion size in chronic survivors: A retrospective study
2022, Journal of Communication DisordersCitation Excerpt :Most often a consequence of stroke, aphasia is an acquired language disorder that occurs in 180,000 stroke survivors annually (Aphasia FAQs. January 5, 2022) . Differences in stroke incidence, access to care, and language impairment have been linked to race and SES (captured by income and education) (Arrich et al., 2008; Hardy et al., 2019). Stroke-related costs in the United States are nearly 53 billion dollars, and the burden of stroke is higher in racial/ethnic minorities (CDC, 2022; Trimble & Morgenstern, 2008).
The Relationship Between Fall Risk and Hospital-Based Therapy Utilization Is Moderated by Demographic Characteristics and Insurance Type
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2024, American Journal of Speech-Language PathologyThe Intersection of Social Determinants of Health and Post-stroke Aphasia Outcomes: A Need for Intersectional Analysis
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Disclosures: none.