Pressure ulcer prevalence and barriers to treatment after spinal cord injury: Comparisons of four groups based on race-ethnicity

Abstract

Objective: To compare the prevalence of pressure ulcer (PU) and barriers to treatment in the event of PU development as a function of race-ethnicity in persons with spinal cord injury (SCI). Methods: Interview data were collected from three rehabilitation hospitals each of which was designated as a model SCI system of care by the United States Department of Education. There were 475 participants with similar portions of each racial-ethnic group (African-American n = 121, American-Indian n = 105, Caucasians n = 127, Hispanics n = 122). Results: The lowest prevalence rates for pressure ulcers were reported by Hispanics followed by Caucasians. Logistic regression revealed racial-ethnic differences in the odds of developing a PU within the past 12 months. Social support and injury severity were also associated with risk of PU while age, gender, years since injury, and education were not. Significant racial-ethnic differences were also observed in 5 of 9 barriers to the treatment of PUs. Conclusion: Results suggest that variability in social support and barriers to treatment may contribute to the racial-ethnic differences in prevalence rates for PU that were observed. Future research in this area could lead to the development of strategies to enhance prevention and treatment targeted at the elimination of any racial-ethnic disparities.

Making Sense of Skin Color in Clinical Care

“…Investigators describe differences in injury patterns, types, severity, and number between people of different races and/or ethnicities with respect to sexual assault, childbirth-related injury, pressure ulcer formation, and healing (Baumgarten et al, 2004; Fogerty et al, 2008; Saladin & Krause, 2009; Sommers, 2007; Sommers et al, 2008). For example, in a population of women studied after consensual sexual intercourse, Sommers et al found that not only was injury prevalence significantly higher in White as compared with Black/African American women, but the effect of race/ethnicity became nonsignificant after adding skin color values to the model predicting occurrence of genital injury (Sommers et al, 2008, 2009).…”

“…Clinicians and researchers have published findings relating the importance of skin color in health care. These include differences in the potential for injury when faced with forces associated with trauma (soft tissue injury), friction/shearing (pressure ulcers), and stretching (childbirth; Howard, Davies, DeLancey, & Small, 2000; Robinson, Norwitz, Cohen, McElrath, & Lieberman, 1999; Saladin & Krause, 2009; Sommers et al, 2009). Accurate evaluation of skin color is important in both clinical and research settings (Bennett, 1995; Berardesca, Derigal, Leveque, & Maibach, 1991; Ha et al, 2009; Lindholm et al, 2008).…”

Racial and Ethnic Disparities in Functioning at Discharge and Follow-Up Among Patients With Motor Complete Spinal Cord Injury

“…13,14 For example, non-Hispanic black individuals living with SCI have higher rates of severe pressure ulcers requiring invasive treatment than their Hispanic and non-Hispanic white counterparts. 8,15,16 Non-Hispanic black and Hispanic women with SCI also report more depressive symptoms in comparison to non-Hispanic black men and non-Hispanic white women and men. 17,18 Only a fraction of persons with SCI attain gainful employment postinjury, and this socioeconomic problem is magnified by a significant employment gap observed between non-Hispanic whites and minority groups.…”

Personality and Behavioral Predictors of Pressure Ulcer History

“…2 Several studies of outcomes after SCI have reported the annual prevalence of PUs to be 32% to 50%. 2,4,5 …”

“…Demographic variables, including age, gender, and race, have been found to be related to PUs after SCI, although not consistently across studies. 3-5,12-14 Being married or cohabitating is protective against PUs. 15 Saladin, Krause, and Adkins 5 assessed barriers to treatment for PUs among a group of racially/ethnically diverse persons with SCI.…”