Social determinants of health and onset of rehabilitation services among individuals with traumatic brain injury

Research Objectives: Early onset of rehabilitation services is associated with functional outcomes at discharge. However, the impact of social determinants of health (SDoH) on early access to acute care rehabilitation services is not well understood. SDoH are defined as the situations in which individuals are born, reside, learn, work, play, and worship, which can influence a wide range of health and quality of life outcomes, including access to health care. We sought to examine the influence of community-level SDoH on early access to rehabilitation services among individuals with TBI.

Design: In a secondary analysis of de-identified electronic health record (EHR) data, multinomial logistic regression models were computed to calculate odds ratios and 95% confidence intervals for the likelihood of early onset of rehabilitation services.

Setting: 14 regional acute care hospitals.

Participants: 5,812 adults with TBI.

Interventions: None.

Main Outcome Measures: 1) Community-level SDoH: Median income: >$96,967; >$61,069-≤$96,967; >$47,500-≤$61,069; and ≤$47,500; Percentage above high school education: < 93.1% vs. ≥ 93.1%; Percentage above bachelors’ education: >47.5%; >34.8%-≤47.5%; >21.7%-≤34.8%; and ≤21.7%; Residence location: Urban vs. Rural.
2)Onset of rehabilitation services in days: No Services; Early (day of admission or 1-day post admission); Minimally delayed(days 2-3 post admission); Delayed (days ≥4 post admission).

Results: Patients living in locations with a median income between $47,500 and $61,069 (vs. median income ≤$47,500) were more unlikely to receive OT (OR=1.704, p < .05) and PT services (OR=1.619, p < .05; vs. receiving delayed services). Patients with mild or moderate severity were more likely to receive early access to OT (OR=3.188, p < .05) and PT services (OR=2.793, p < .05; vs. receiving delayed services) compared to those with severe TBI. Other indicators of community-level SDoH were not associated with onset of rehabilitation services.

Conclusions: Other, individual-level variables, such as age, comorbidity burden, and TBI severity, demonstrated clear relationships with therapy onset. Further research is needed to determine whether our SDoH variables were too diffuse to capture individual experiences and impacts on care or whether community-level education and income, and residence location truly do not influence time to therapy for patients hospitalized with TBI.

Author(s) Disclosures: None.