Introduction: The racial disparity of stroke outcomes is well documented in the US Civilian Healthcare system. In contrast, the Military Healthcare system is a single payer system (Every member has the same health benefits). Does this affect outcomes?
Hypothesis: We hypothesize there will be no difference in Healthcare outcomes within the Military Healthcare system when the effects of race and rank (socioeconomic surrogate) are considered.
Methods: Data was collected from the Defense Health Agency Military Mart (M2) database from fiscal year 2010 to 2016 (All admissions to military care facilities). The M2 database stores data including rank and race. Adult patients with a primary diagnosis of stroke at discharge (International Classification of Diseases, 9th Revision codes 434.91, 434.11 or 10th Revision code I63.9) were reviewed. Race and Rank were compared for Duration of hospitalization, total Cost of the hospitalization and Outcome (disposition status) using Multivariate Analysis.
Results: A total of 3,910 patients discharged from Military hospitals were identified. The racial composition of this sample was: White 50.1%, Black 17.3%, Asian 7.2%, Other 2.9%, and Unknown/Not Reported 22.5%. There was no correlation between race and Duration of hospitalization, total Cost of the hospitalization or Outcome. Military Rank was identified with 2,134 (54.6%) of the 3,910 patients in the study. The Rank identified study population was: Senior Enlisted 71.4%, Senior Officers 18.2%, Junior Enlisted 4.9%, Junior Officers 2.9% and Warrant Officers 2.5%. There was no correlation between Rank and Duration of hospitalization or total Cost of the hospitalization. There was a statistically significant trend to better Outcome for higher rank then lower (p<0.05).
Conclusions: Racial disparities evident in the Civilian Healthcare system do not appear to transfer to the Military Healthcare system. Rank (as a socioeconomic surrogate) did have a trend toward better Outcomes with higher rank.