Original research| Volume 100, ISSUE 2, P254-260, February 2019

Urban-Rural Differences in Service Utilization and Costs of Care for Racial-Ethnic Groups Hospitalized With Poststroke Aphasia

Published:August 10, 2018DOI:



      Although residence is a key contributor to cost and utilization in stroke patient care, its contribution to the care of persons with aphasia (PWA) is unknown. The objective of this study was to use discharge-level hospital inpatient data to examine the influence of patient residence (rural vs urban) and race-ethnicity on service utilization and cost of care among PWA.




      Administrative data from acute care hospitals in the state of North Carolina.


      Individuals (N=4381) with poststroke aphasia.



      Main Outcome Measures

      Length of stay (LOS), speech-language pathology (SLP) service utilization, costs of care.


      The 2011-2012 Healthcare Cost and Utilization Project State Inpatient Database data were analyzed to examine the effect of rural or urban residence on LOS, SLP service utilization, as well as total inpatient and SLP service costs. These outcomes were further analyzed across both residence and racial groups (non-Hispanic white and non-Hispanic black). Outcomes were analyzed using generalized linear model.


      Both rural and urban black PWA experienced longer average LOS after controlling for demographics, illness severity, and the hospital where they received care. Rural blacks experienced longer LOS, received greater SLP services, and incurred greater average total hospital costs than their rural white counterparts after adjusting for differences in their demographics and stroke or illness severity. The differences were attenuated after controlling for the hospital where they received care.


      For PWA, race-ethnicity has a larger effect on average total medical costs, SLP service utilization, and LOS than residence. It is unclear how and why blacks with aphasia have greater service utilization and costs in acute care, yet their aphasia outcomes are worse. Future studies are required to explore potential factors such as quality of care.


      List of abbreviations:

      GLM (generalized linear model), HCUP (Healthcare Cost and Utilization Project), HSR (health services research), ICD-9 (International Classification of Diseases and Health Related Problems, Ninth Revision), LOS (length of stay), PWA (persons with aphasia), RUCA (rural-urban commuting area), SLP (speech-language pathology)
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