title: To What Extent Do Neighborhood Differences Mediate Racial Disparities in Participation After Spinal Cord Injury?
abstract: OBJECTIVE
  To examine the role of residential neighborhood characteristics in accounting for race disparities in participation among a large sample of community-living adults with chronic spinal cord injury (SCI).
  
  
  METHODS
  Secondary analysis of cross-sectional survey data from the national Spinal Cord Injury Model Systems (SCIMS) database linked with national survey and spatial data.
  
  
  METHODS
  SCIMS database participants enrolled at 10 collaborating centers active in follow-up between 2000 and 2014.
  
  
  METHODS
  The sample consisted of persons with SCI (N=6892) in 5441 Census tracts from 50 states and the District of Columbia.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  The Craig Handicap Assessment and Reporting Technique was used to measure full participation across 4 domains: physical independence, mobility, occupation, and social integration.
  
  
  RESULTS
  Racial minority groups had lower odds of reporting full participation relative to whites across all domains, suggesting that blacks and Hispanics are at risk for poorer community reintegration after SCI. Neighborhood characteristics, notably differences in socioeconomic advantage, reduced race group differences in the odds of full occupational and social integration, suggesting that the race disparities in community reintegration after SCI are partially attributable to variation in the economic characteristics of the places where people live.
  
  
  CONCLUSIONS
  This investigation suggests that addressing disadvantage at the neighborhood level may modify gaps in community participation after medical rehabilitation and provides further support for the role of the environment in the experience of disability.
authors.affiliation: Kessler Foundation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ. Electronic address: abotticello@kesslerfoundation.org.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Botticello
authors.affiliation: Departments of Physical Medicine and Rehabilitation, Bioengineering, and Rehabilitation Science and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Mike
authors.initials: M
authors.lastname: Boninger
authors.affiliation: Craig Hospital, Denver, CO.
authors.forename: Susan
authors.initials: S
authors.lastname: Charlifue
authors.affiliation: University of Alabama, Birmingham, AL.
authors.forename: Yuying
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Kessler Foundation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ.
authors.forename: Denise
authors.initials: D
authors.lastname: Fyffe
authors.affiliation: Rehabilitation Institute of Chicago and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Allen
authors.initials: A
authors.lastname: Heinemann
authors.affiliation: University of Washington, Seattle, WA.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Hoffman
authors.affiliation: Boston University, Boston, MA.
authors.forename: Alan
authors.initials: A
authors.lastname: Jette
authors.affiliation: University of Michigan, Ann Arbor, MI.
authors.forename: Claire
authors.initials: C
authors.lastname: Kalpakjian
authors.affiliation: Department of Science and Engineering, Raritan Valley Community College, Branchburg, NJ.
authors.forename: Tanya
authors.initials: T
authors.lastname: Rohrbach
mesh_terms: D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000523:psychology*; D004777:Environment; D005260:Female; D006304:Health Status; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009790:Occupations; D011788:Quality of Life; D044469:Racial Groups / Q000523:psychology*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D058992:Social Participation / Q000523:psychology*; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000208:ethnology / Q000523:psychology*; D015599:Trauma Severity Indices
keywords: Environment; Health status disparities; Minority health; Rehabilitation; Residence characteristics; Spinal cord injuries