Relationship of pressure ulcers, race, and socioeconomic conditions after spinal cord injury

Objective: To identify risks factors associated with pressure ulcers (PrU) after spinal cord injury (SCI) by examining race and socioeconomic status (SES), measured by income and education. We hypothesize African-Americans will have a greater risk for PrUs than whites but this relationship will be mediated by the two SES indicators. Methods: 1,466 white and African-American adults with traumatic SCI, at least 1 year post-injury participated in a mail-in survey from a large rehabilitation hospital in the Southeastern United States. Three specific PrU outcomes were measured: 1) PrUs in the past year, 2) current PrU, 3) surgery to repair a PrU since injury. Logistic regression was used to assess the relationships of race and SES with each PrU outcome. Results: Preliminarily, race was significantly associated with having a current PrU and with having surgery to repair a PrU since injury. However, in multivariable analyses, the relationships of race with having a current PrU and with surgery to repair a PrU were mediated by SES such that the relationships were no longer significant. Lower income was associated with increased odds of each PrU outcome. After controlling for other variables, education was associated with increased odds of having a current PrU. Conclusion: Our findings help to clarify the relationships between race and SES with PrUs after SCI. Specifically, a lack of resources, both financial and educational, is associated with worse PrU outcomes. Results can be used by providers and policy makers when considering prevention and intervention strategies for PrUs after SCI.