Informal caregivers and racial/ethnic variation in health service use of stroke survivors.

Abstract

We investigated the racial and ethnic variation in health service use among stroke survivors with informal caregivers in a number of Department of Veterans Affairs Medical Centers in one Veterans Integrated Service Network in the southeastern United States. We focused on the role of caregivers as an enabling factor in the use of health services. One hundred twenty-five veterans who had been hospitalized after an acute stroke, been released home, and identified an informal caregiver were enrolled in the study. Veterans and caregivers were surveyed at four time points over 12 months. Poisson multivariate regression analyses were used to model the relative risk (RR) of health service use. African Americans and Puerto Ricans were half as likely as Caucasians to use inpatient therapy services (RR = 0.522 and 0.494, respectively; p < 0.01), Puerto Ricans were less likely to be admitted to the hospital (RR = 0.689, p < 0.05), and Puerto Ricans were more likely to use outpatient services than Caucasians (RR = 1.230, p < 0.01). Stroke survivors that received more hours of informal care were associated with a higher likelihood of outpatient service use (RR = 1.01, p < 0.01). Stroke survivors living with their caregiver had a lower likelihood of inpatient therapy use (RR = 0.791, p < 0.01) and a higher likelihood of outpatient service use (RR = 1.17, p < 0.01). Greater likelihood of inpatient therapy (RR = 1.340, p < 0.01) and outpatient services (RR = 1.160, p < 0.05) was related to caregivers who received outside help. This study provides insight into the role of informal care in health service use for stroke survivors.