Disparities in subjective well-being, participation, and health after spinal cord injury: a 6-year longitudinal study.

OBJECTIVE: To identify disparities and changes in subjective well-being, participation, and health over a 6-year period as a function of race-ethnicity and gender in persons with spinal cord injury (SCI). METHODS: Stratified sampling was used to maximize inclusion of women and racial-ethnic minorities. Three model SCI systems participated, representing the Southeastern, Western, and Mountain regions of the United States. 250 participants completed measures on two occasions. Similar portions of Caucasians (n = 62), African-Americans (n = 61), American-Indians (n = 56), and Hispanics (n = 71) participated. Women made up approximately 43.1% of the sample. Three sets of outcome measures assessed: (a) subjective well-being and depressive symptoms, (b) participation, and (c) health. RESULTS: MANOVA indicated significant effects for race-ethnicity (between subjects effect) and time (within subjects effect) but not for gender or the interaction effects. A Bonferroni correction was used to compare outcomes as a function of race-ethnicity and time. Five outcomes were significantly related to race-ethnicity, whereas no items were significantly related to the time effect after the Bonferroni correction. Caucasians reported best subjective well-being scores in several domains followed by African-Americans. Caucasians also reported more hours out of bed than either African-Americans or Hispanics. CONCLUSION: Over a 6-year period, race-ethnicity continued to be related to differences in subjective well-being and participation but not health. Disparities in outcomes did not systematically increase or diminish over time, suggesting that once developed, such disparities are unlikely to change in the absence of intervention.

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

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.

Racial disparities in health outcomes after spinal cord injury: mediating effects of education and income.

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 1342 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.