Race: predictor versus proxy variable? Outcomes after spinal cord injury.
OBJECTIVE
To examine the impact of race on acute, rehabilitation, and long-term outcomes after spinal cord injury (SCI).


METHODS
Two case control studies (study 1: acute and rehabilitation outcomes, study 2: long-term outcomes) in which white and nonwhite individuals were matched case for case on multiple demographic, medical, and geographic characteristics with the rationale being that a case-control methodology would increase the internal validity of the design, thereby increasing confidence in the assertion that any between-group differences observed may be specifically attributed to race.


METHODS
Data drawn from the Spinal Cord Injury Model Systems. Institutional practice and general community.


METHODS
Study 1: 187 pairs of individuals, study 2: 158 pairs of matched individuals.


METHODS
Not applicable.


METHODS
Outcome measures assessed included economic (eg, cost of care), treatment-related (eg, length of hospital stay), functional (eg, FIM instrument), and medical (eg, number of medical complications) variables, as well as self-reported life satisfaction, level of handicap, and mental and physical health.


RESULTS
In study 1, none of the outcome measures differed significantly across racial groups. Similarly, study 2 failed to indicate significant differences in any of the outcome variables across racial groups, with the exception that nonwhites were at increased risk of greater self-reported handicap in the area of mobility. Power analyses indicated these finding were not merely the result of inadequate power.


CONCLUSIONS
For the outcomes assessed in studies 1 and 2, race appeared to act primarily as a proxy for other variables (eg, injury severity, age, educational achievement), which in turn may be associated with poor outcome after SCI. Theoretical implications and recommendations are discussed.
Putzke
John David
JD
Department of Physical Medicine and Rehabilitation, University of Alabama, 1717 6th Avenue S, Birmingham, AL 35233-7330, USA.
Hicken
Bret L
BL
Richards
J Scott
JS
D000203:Activities of Daily Living; D000208:Acute Disease; D000328:Adult; D001741:Black or African American / Q000193:education / Q000523:psychology / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data; D006302:Health Services Research; D006304:Health Status; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008134:Long-Term Care / Q000458:organization & administration / Q000523:psychology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011237:Predictive Value of Tests; D011788:Quality of Life; D013119:Spinal Cord Injuries / Q000150:complications / Q000191:economics / Q000208:ethnology* / Q000523:psychology / Q000534:rehabilitation*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000193:education / Q000523:psychology / Q000706:statistics & numerical data*