Sex differences in location of initial diagnosis and discharge destination among medicare fee-for-service beneficiaries with post-stroke aphasia.

OBJECTIVE: To characterize sex differences in the clinical setting of initial aphasia diagnosis and the discharge destination of fee-for-service (FFS) Medicare beneficiaries diagnosed with post-stroke aphasia. METHODS: Data for this project were obtained from 100% of FFS Medicare claims and included all beneficiaries who incurred an inpatient claim between January 2016 and October 2019 listing stroke as the primary diagnosis and had a claim listing aphasia diagnosis within 90 days of stroke. RESULTS: Among those diagnosed with stroke (745,917), 14.5% (N = 107,753) were also diagnosed with aphasia within 90 days. Approximately 60.96% of men and 56.47% of women had their initial aphasia-related claim in an inpatient facility; 15.12% of men and 19.47% of women in a skilled nursing facility; and 8.44% of men and 7.03% of women in an outpatient facility. Roughly 14.99% of men and 11.50% of women with aphasia were discharged home; 25.38% of men and 31.37% of women were discharged to a skilled nursing facility; and 42.94% of men and 38.24% of women were discharged to a long-term care or rehabilitation facility (χ2 =904.70, p < 0.0001). Relative to men, women were significantly more likely to be discharged to a skilled nursing facility (OR = 1.35, 95% CI = 1.31, 1.39), but less likely to be discharged to a long-term care or rehabilitation facility (OR = 0.83, 95% CI = 0.81, 0.86). DISCUSSION: Sex differences existed in the location of aphasia diagnosis and their destination following acute care discharge. However, the cause of these differences is unknown or how they related to quality-of-care.