3068 — Racial/Ethnic Disparities in Access to VA Services as a Pathway to Mortality Differentials among Veterans Diagnosed with TBI
Dismuke CE, Gebregziabher M, Echols C, and Egede L, Ralph H. Johnson VAMC;
The VA healthcare system has been referred to as a “beacon of hope” for a potential health reform model in the US. Even so, there is recent evidence of racial/ethnic disparities in mortality among Veterans diagnosed with Traumatic Brain Injury (TBI) (Egede, Dismuke, Echols 2011) This study aims to examine the association of health services utilization with mortality and race/ethnicity with TBI treatment access of Veterans clinically diagnosed with TBI.
A National cohort of 7,885 Non-Hispanic White, 1,748 Non-Hispanic Black, 314 Hispanic, and 4,743 other/missing race/ethnicity Veterans clinically diagnosed with TBI between January 1, 2006 and December 31, 2006 in VA medical centers and community-based outpatient clinics was assembled. All Veterans were followed from January 1, 2006 through December 31, 2009 or until date of death. VA TBI treatment services access and utilization was tracked for 12 months after first recorded TBI ICD 9 diagnosis code.
Overall mortality at 48 months was 6.7% in Hispanic Veterans, 2.9% in Non-Hispanic White Veterans, and 2.7% in Non-Hispanic Black Veterans. In a mortality model adjusting for total demographic and comorbid conditions, Hispanic ethnicity was associated with a higher likelihood of mortality. However, after inclusion of total utilization, race/ethnicity was no longer significant. In access models adjusting for race/ethnicity, Hispanic ethnicity was associated with a higher likelihood of not accessing TBI clinic (HR 2.21; 95% CI 1.40:3.49), neurology (HR 2.18; 95% CI 1.38:3.45), imaging (HR 2.40; 95% CI 1.53:3.75), mental health (HR 2.46: 95% CI 1.57:3.85), and rehabilitation (HR 2.32; 95% CI 1.49:3.63) services in VA hospitals and clinics.
Hispanic ethnicity is positively associated with higher mortality risk among Veterans clinically diagnosed with TBI. This association appears to be due to a higher likelihood of Hispanic Veterans not accessing services important in the treatment of TBI.
Further research needs to be conducted to determine whether access disparities are based on language, cultural or other barriers which VA should target to reduce with innovative care access interventions.