Racial Disparities in Health Outcomes After Spinal Cord Injury: Mediating Effects of Education and Income

Abstract

Objective: The purpose of this study was to investigate heath disparities as a function of race and gender and the extent to which socioeconomic factors mediate disparities among participants with spinal cord injury.Design: Survey methodology. Cross-sectional data.Setting: A large Southeastern specialty hospital.Participants: There were 1,342 participants in the current analysis, all of whom were identified from patient records. There were 3 inclusion criteria: (a) traumatic SCI, (b) at least 18 years of age at the time of study, and (c) injury duration of more than 1 year.Main outcome measures: Six outcomes were measured, including 3 general outcomes (self-ratings, days impacted by poor health, days impacted by poor mental health) and 3 that reflect utilization of services (hospitalizations, days hospitalized, and nonroutine physician visits in the past 2 years). Results:Results of multivariate analysis of variance (MANOVA) indicated significant main effects for both race and gender. Follow-up tests identified racial disparities on 3 of the 6 outcomes, whereas gender disparities were observed for a single outcome. Years of education and household income mediated interrelationships between race and health (but not gender) as racial disparities disappeared after consideration of these factors.Conclusions: These findings suggest the need to work more diligently to promote better health outcomes among African Americans and to further investigate how socioeconomic factors and access to health care related to diminished health outcomes among African Americans with spinal cord injury.

How Are Race, Cultural, and Psychosocial Factors Associated With Outcomes in Veterans With Spinal Cord Injury?

“…2–7 Racial and ethnic minorities also have an increased risk of secondary complications (e.g., pain, pressure ulcers) and poorer self-care ability as compared to whites (WH). 5, 8–12 Similarly, previous studies have found higher rates of depressive symptomatology and lower rates of post-injury employment among minority wheelchair users with SCI, as compared to their WH counterparts. Further, WH versus minority race differences in pain severity and pain interference were significantly associated with differences in subjective wellbeing.…”

The Relationship of Pressure Ulcers, Race, and Socioeconomic Conditions After Spinal Cord Injury

“…Studies have shown that low SES, including low income, occupation type, and education, is consistently related to reduced access to quality health care (12). Further examination of the problematic health care issues shows that the populations most often affected are minority groups (13). African Americans tend to have less education and lower income and experience poverty at all ages, as opposed to whites (12).…”

Longitudinal Analysis of Hospitalization After Spinal Cord Injury: Variation Based on Race and Ethnicity

“…8,14 In particular, the disproportionate representation of African American adults among the lower educated groups, as well as their reported likelihood of being unmarried and unemployed at the time of injury, might suggest a decreased likelihood of accessing preventive health care services and an increased likelihood of experiencing medical complications; all of these are considered risk factors, increasing the probability of hospitalization. 8,14 Also notable among the findings were the positive outcomes and reduced rate of hospitalizations among Hispanic adults. One possible explanation might be the importance of family and social support within Latino/Hispanic culture.…”

“…Second, there were important confounding variables such as income level and overall socioeconomic status, health insurance, lifestyle or cultural indicators, accessibility of physician services, and quality and use of caregiver services that either were not measured or had too many missing values to be included in the analysis. Prior studies 8,14 show that some of these factors have strong associations with health outcomes. Third, findings from this study may not be generalized to SCI survivors in the United States because the SCIMS database is not nationally representative and collects data only from 26 SCI centers.…”

“…3,13 Although these studies have defined the overall rates of hospitalization after SCI, only a few examined the effect of race/ethnicity while controlling for other risk factors. 8,14 There is a gap in the literature with regard to longitudinal analysis of hospitalization among minorities with SCI. Longitudinal studies are inherently subject to attrition; however, they allow researchers to look at change between and within subgroups over time.…”