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

Abstract

Objective: To identify risks factors associated with pressure ulcers (PrU) after spinal cord injury (SCI) by examining race and indicators of socioeconomic status (measured by income and education). We hypothesize African Americans will have a greater risk for PrUs than whites, but this relationship will be mediated by the 2 socioeconomic status indicators. Design: Cohort study. Setting: A large rehabilitation hospital in the southeastern US. Participants: 1,466 white and African American adults at least 1-year post-traumatic SCI. Outcome Measures: (a) PrUs in the past year, (b) current PrU, (c) surgery to repair a PrU since injury. Results: In preliminary analyses, race was significantly associated with having a current PrU and with having surgery to repair a PrU since injury. In multivariable analyses, the relationships of PrU with having a current PrU and with having surgery to repair a PrU were both mediated by income and education such that the relationships were no longer significant. Lower income was associated with increased odds of each PrU outcome. After controlling for other variables in the model, education was associated with increased odds of having a current PrU. Conclusion: These findings help clarify the relationships between race and socioeconomic status with PrUs after SCI. Specifically, a lack of resources, both financial and educational, is associated with worse PrU outcomes. These results can be used by both providers and policy makers when considering prevention and intervention strategies for PrUs among people with SCI.

Demography, Diagnosis and Complications of Spinal Cord Injury Patients in a Rehabilitation Center of Bangladesh

“…It was found that 93 of the respondent (47%) were employed and 103 were unemployed (57%) which somewhat correlate with Zahangir et al, who reported 36% of the patient to be day laborer [18] and also Ulrich et al, according to whom only 22% of the patients were full time employed but does not go in line with Lali et al and other articles [4,14,17,22] (Table 1). A general trend of development of pressure sore among people with low income was found in this study which was also common in the other reports [4,11,18,19]. Most of the respondents of this study had paraplegia (56.5%) and the principle cause was trauma which was similar to the report Rahman et al but Guihan et al reported most of their patients (73.3%) had complete spinal cord injury [10, 14,20] but in all the reports the major cause of injury was reported to be trauma whether road traffic accident or fall from height or any other mechanism of traumatic injury [4,10,11,14,20,21] ( Figure 1).…”

“…A general trend of development of pressure sore among people with low income was found in this study which was also common in the other reports [4,11,18,19]. Most of the respondents of this study had paraplegia (56.5%) and the principle cause was trauma which was similar to the report Rahman et al but Guihan et al reported most of their patients (73.3%) had complete spinal cord injury [10, 14,20] but in all the reports the major cause of injury was reported to be trauma whether road traffic accident or fall from height or any other mechanism of traumatic injury [4,10,11,14,20,21] ( Figure 1). Regarding the location, the authors found Buttock to be the predominant site for developing site pressure sore as evident form 67.5% patient had sore over their buttock followed by Ischial tuberosity (7.5%) and this finding was similar to Hossain et al and Ulrich et al reported the lower back to the commonest site for pressure sore [17,22] (Table 3).…”

“…The Demographic variables author took into consideration were sex, age, employment status and income of the patient. Out of 201 study population 176 were male and 25 were female and this male predominance was also reported in the previous studies carried out both locally [14,[18][19][20] and globally [4][5][6][7][8][9][10][11]21] (Table 1). In this study most of the patients were in their 3 rd decade which consisted 28.6% , followed by 27.4% in between 21-30 years and 26.8% in between 41-50, which was also a common finding as reported by Hossain et al [22] where mean age was 47.44 ± 13.30 [17]; Ulrich et al found it 36.1 and according to Lali et al [21] mean age was 35.3, but in some studies the age of the study population was little bit different [4,14,16,18] (Table 1).…”

Impact of Marital Status on 20-Year Subjective Well-being Trajectories

“…All other covariates were time invariant and were measured at 1993 (we use the values obtained at the first time of measurement). These included chronological age, age at injury, race (White, non-Hispanic vs others), gender (male vs female), injury severity (nonambulatory, C1-C4; nonambulatory, C5-C8; nonambulatory, noncervical; ambulatory), 20,21 and years of education. For easy interpretation, we recentered the 2 aging variables to their own sample means before performing the analysis.…”

Diabetes increases financial burden of individuals with traumatic spinal cord injury (TSCI)

“…TSCI severity was classified into a categorical variable with four groups: C1-C4 cervical, C5-C8 cervical and noncervical nonambulatory and ambulatory. 8,9 Statistical analysis Frequency of the income intervals and income model covariates were computed for the entire sample and by diabetes status. χ 2 was used to test for differences in income model binary and categorical covariates by diabetes status.…”