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.


METHODS
Survey methodology. Cross-sectional data.


METHODS
A large Southeastern specialty hospital.


METHODS
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.


METHODS
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.
Medical University of South Carolina, Charleston, South Carolina, USA. lynne_broderick@shepherd.org
James S
JS
Krause
Lynne E
LE
Broderick
Lisa K
LK
Saladin
Joy
J
Broyles
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D012047:Rehabilitation Centers; D012737:Sex Factors; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000208:ethnology* / Q000534:rehabilitation; D014481:United States; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American