Disparities in Health Care for Black Patients in Physical Medicine and Rehabilitation in the United States: A Narrative Review

Abstract

Racial health disparities continue to disproportionately affect Black persons in the United States. Black individuals also have increased risk of worse outcomes associated with social determinants of health including socioeconomic factors such as income, education, and employment. This narrative review included studies originally spanning a period of approximately one decade (December 2009‐December 2019) from online databases and with subsequent updates though June 2020. The findings to date suggest pervasive inequities across common conditions and injuries in physical medicine and rehabilitation for this group compared to other racial/ethnic groups. We found health disparities across several domains for Black persons with stroke, traumatic brain injury, spinal cord injury, hip/knee osteoarthritis, and fractures, as well as cardiovascular and pulmonary disease. Although more research is needed, some contributing factors include low access to rehabilitation care, fewer referrals, lower utilization rates, perceived bias, and more self‐reliance, even after adjusting for hospital characteristics, age, disease severity, and relevant socioeconomic variables. Some studies found that Black individuals were less likely to receive care that was concordant with clinical guidelines per the reported literature. Our review highlights many gaps in the literature on racial disparities that are particularly notable in cardiac, pulmonary, and critical care rehabilitation. Clinicians, researchers, and policy makers should therefore consider race and ethnicity as important factors as we strive to optimize rehabilitation care for an increasingly diverse U.S. population.

Could routine race-adjustment of spirometers exacerbate racial disparities in COVID-19 recovery?

“…This notion is of particular concern considering Black patients are already less likely than White patients to be referred to pulmonary rehabilitation, despite more frequent pulmonary-related hospitalisations. 9 We urge health-care providers to be aware of the racial disparities that might be exacerbated by using race-corrections in spirometry, particularly during a pandemic that affects respiratory function. Currently, there is no known major genetic locus that varies by race that can explain racial disparities in lung function; however, body proportions, socioeconomic status, and occupational hazards clearly influence capacity.…”

Social Determinants of Health in Physiatry: Challenges and Opportunities for Clinical Decision Making and Improving Treatment Precision

“…SDH are vital to collaborative short and long-term goal setting with the patient and family, with establishing home safety parameters, setting expectations for rate and type of functional gains, and reintegration into social-vocational roles. In the outpatient setting, SDH affects symptom progression, mental health, social functioning and access to the amount or type of services obtained for a given diagnosis ( 29 ). Commonly measured SDH each care setting are summarized in Supplementary Table 1 .…”

“…For many conditions, early intensive rehabilitation can optimize functionality and re-engage patients back into life. SDH that affect referral to post-acute services include gender, race ( 29 , 32 ), age, payor source ( 32 ), place of living (community alone, community with others, nursing home) ( 30 ), social support or living status, and geographic region ( 23 ). For medically-complex conditions, such as dysvascular amputation, inpatient rehabilitation referrals occur more often when the patient is married, has Medicaid and lives in a city; older, unmarried patients with history of nursing home residence are more often referred to skilled nursing facilities (SNF) ( 23 ).…”

Community-Based Culturally Tailored Education Programs for Black Adults with Cardiovascular Disease, Diabetes, Hypertension, and Stroke: A Systematic Review Protocol

“…12,13 Moreover, Odonkor & colleagues noted that "Black individuals were less likely to receive care that was concordant with clinical guidelines per the reported literature". 14 Health disparities among Black communities have been recognized for decades, but specific programs meant to address them have yet to become a priority within the medical field. 15 Although it is not a predominant intervention strategy, a growing body of literature have called for culturally-tailored community-based (CBCT) programs to reduce health disparities and improve health outcomes for racialized communities.…”