Association of Race, Socioeconomic Status, and Health Care Access with Pressure Ulcers after Spinal Cord Injury
Rigor and Relevance of Disability Research Evidence
Objective: To assess the associations of race, socioeconomic status (SES) with pressure ulcers (PU) after accounting for health care access (HCA) among persons with spinal cord injury (SCI).
We used a cross-sectional design in this study of persons with traumatic SCI who 1) had residual effects from their SCI, 2) were 18 years or older at survey, and 3) were a year or more post-injury at survey (n=2,549). Three analyses were conducted looking at the association of race, SES, and HCA with: 1) having a current PU, 2) having had reduced sitting time due to a PU in the past year, 3) having ever had surgery for a PU.Of participants, 39.3% reported a PU in the past year, 19.9% had a current PU, and 21.9% reported having had surgery for a PU since their SCI onset. 10.4% of participants reported having their sitting time reduced by more than a month due to a PU in the past year. While race was preliminarily associated with each PU outcome, it became non-significant after controlling for SES and HCA. In each analysis, household income was significantly associated with PU outcomes after controlling for demographic and injury factors and remained significant after accounting for the HCA factors. Persons with lower income (<$25,000 per year) had higher odds of each PU outcome than those with higher income (>$75,000 per year). Among HCA variables, persons who could not see a doctor because of cost were significantly more likely to have a current PU. Having insurance was consistently unrelated to PU outcomes. Even after accounting for HCA, household income remained significantly associated with PU outcomes after SCI; however, race became non-significant. These results highlight the importance of SES, specifically annual household income, in relation to PU outcomes after SCI.