Racial disparities in outcomes after spinal cord injury

Abstract

Spinal Cord Injury (SCI) is an acute trauma to the neural elements resulting in temporary or permanent sensory and motor deficit. Studies have indicated that although 66% of SCI occur in Caucasians, there are a growing number of other racial groups affected by SCI. Furthermore, there has been a lack of research concerning racial disparities in outcomes following SCI. As such, a retrospective analysis using the National Trauma Data Bank (NTDB) from 2000 to 2009 was performed. African Americans, Caucasians, Hispanics, Asians, and Native Americans were included in the study. We calculated adjusted odds ratios (OR) to examine the relationship between racial backgrounds and mortality, length of intensive care unit (ICU) stay, length of hospital stay, in-hospital complications, and patient disposition. Our results showed that significant differences were found in length of hospital stay, with African American and Hispanic populations having longer hospital stays than Caucasian and Asians. For all type complications, African Americans (OR 1.228, confidence interval [CI] 1.11-1.356) and Native Americans (OR 1.618, CI 1.083-2.419) were more likely than Caucasian and Hispanic patients to have in-hospital complications. For disposition status, African Americans (OR 0.844, CI 0.730-0.976) and Asians (OR 0.475, CI 0.297-0.760) were much less likely than Caucasians or Hispanic populations to be discharged to an acute rehabilitation program. The results from this large-scale study (n=18,671) demonstrate a number of racial disparities following SCI at the national level, including rate of complications, length of stay, and disposition to acute rehabilitation centers. This should raise awareness to cultural differences but also serve as an opportunity to reduce gaps in care across ethnicities for this universally life-altering condition.