Disparities in Physical Function and Rehabilitation Utilization: A Cross-sectional Study of Patients Hospitalized for Acute Medical Illness.

BACKGROUND: Black patients have poorer physical function and mobility compared to White patients but utilize physical rehabilitation services less. OBJECTIVE: To determine whether racial differences exist in physical function and post-acute care facility utilization and whether neighborhood social disadvantage influences these differences. DESIGN: A cross-sectional study of hospitalized patients at a large urban academic hospital. PARTICIPANTS: We included self-identified Black or White adults who were hospitalized between January 2018 and May 2022. MAIN MEASURES: The main exposure was self-identified race. The exposure in our secondary aim was neighborhood social disadvantage measured by the Area Deprivation Index. Neighborhood disadvantage was categorized as "more" (deciles 6-10) vs. "less" (deciles 1-5). Primary outcomes included inpatient functional measures, inpatient and post-acute physical therapy referral, and discharge location. KEY RESULTS: Compared to White patients, Black patients had more functional impairment on admission [OR 1.52; 95% CI (1.37, 1.69)], poorer mobility change [β-0.83; 95% CI (- 1.16, 0.50)], more mobility loss [OR 1.25; 95% CI (1.12, 1.41)], but no statistically significant difference in inpatient PT referrals after adjusting for physical function. Most differences in function persisted when stratified by neighborhood disadvantage. Despite similar odds of recommendation for discharge to a PAC facility, Black patients had significantly lower odds of discharge to a facility [OR 0.53; 95% CI (0.42, 0.68). This difference persisted when stratified by more neighborhood disadvantage [OR 0.60; 95% CI (0.43, 0.85)] and less neighborhood disadvantage [OR 0.43; 95% CI (0.31, 0.61)]. CONCLUSION: In this study of patients hospitalized at a large urban academic medical center, Black patients had poorer functional outcomes yet nearly half the likelihood of discharging to a post-acute care facility compared to White patients. Race was a more consistent driver of disparities than neighborhood disadvantage. Hospital, healthcare system, and public policy changes are needed to improve discharge location appropriateness and recovery after hospitalization for vulnerable patients.

Duke Scholars

Author Joshua Kurt Johnson Orthopaedic Surgery, Physical Therapy