SEX/GENDER DIFFERENCES IN SERVICE USE PATTERNS, CLINICAL OUTCOMES AND MORTALITY RISK FOR ADULTS WITH ACQUIRED BRAIN INJURY: A RETROSPECTIVE COHORT STUDY (ABI-RESTART)

OBJECTIVE: To identify sex/gender differences in functional, psychosocial and service use patterns in community-based post-acute care for acquired brain injury. DESIGN: Retrospective cohort study. SUBJECTS/PATIENTS: Adults with acquired brain injury enrolled in post-acute neurorehabilitation and disability support in Western Australia (n = 1,011). METHODS: UK Functional Independence Measure and Functional Assessment Measure (FIM + FAM), Mayo-Portland Adaptability Inventory-4, goal attainment, length of stay (LOS), number of episodes of care and deaths were evaluated using routinely collected clinical and linked administrative data. RESULTS: At admission, women were older (p < 0.001) and displayed poorer functional independence (FIM + FAM; p < 0.05) compared with men. At discharge, there were no differences in goal attainment, psychosocial function or functional independence between men and women. Both groups demonstrated functional gains; however, women demonstrated clinically significant gains (+ 15.1, p < 0.001) and men did not (+ 13.7, p < 0.001). Women and men had equivalent LOS (p = 0.205). Aboriginal and/or Torres Strait Islander status predicted longer LOS for women but not for men. Being partnered predicted reduced LOS for women but not men. Women had a higher risk of multiple episodes of care (p < 0.001), but not death (p = 0.409), compared with that of men. CONCLUSION: At admission to rehabilitation and disability support services for acquired brain injury, women have poorer functional independence and higher risk of multiple episodes of care, compared with men, suggesting greater disability in the community. By the time of discharge from these services, women and men make equivalent functional and psychosocial gains. The higher risk of multiple episodes of care for women relative to men suggest women may need additional post-discharge support, to avoid readmission. LAY ABSTRACT Acquired brain injury is associated with long-term consequences for health and wellbeing. Despite this, relatively little research has examined sex and gender differences in patterns of service use, functional and psychosocial outcomes, and risk of death in post-acute care for acquired brain injury. This study evaluates the admission and discharge characteristics of 1,011 adults with acquired brain injury. Findings indicate that, while women present with poorer functional independence at admission, post-acute care for acquired brain injury provides opportunities for equivalent functional and psychosocial gains for men and women. Women are at higher risk of requiring multiple episodes of care, compared with men, and women in some groups have a longer length of stay in post-acute care than men, although they are at no greater risk of death during care. This indicates that additional post-discharge support may be required for women with acquired brain injury, but that post-acute care supports both men and women to make meaningful functional improvements.