Participation Differences by Race, Socioeconomic Status, and Neighborhood among Adults with Chronic Mobility Impairment

The purpose of this investigation was to 1) describe gaps in participation among adults with chronic and severe mobility impairment by race/ethnicity, socioeconomic status (SES), and neighborhood characteristics; and 2) examine possible interactions among these factors.  Cross-sectional data on disabled persons were obtained from a national registry of persons with spinal cord injuries. Analyses were conducted on a subset of 6,105 adults over age 18 who were interviewed between 2000 and 2012, reported living in the community, and had Census tract data.  Physical, mobility, occupational, and social participation were self-reported using the Craig Handicap Assessment and Reporting Technique and dichotomized (i.e., full versus impaired participation) for all analyses. Race/ethnicity (i.e., Black, Hispanic, Asian, and Non-Hispanic White (NHW)) and educational level were used to measure individual background differences. Neighborhood characteristics were operationalized with Census tract indicators of median household income (logged) and proportion of residents receiving public assistance. Multilevel logistic regression models adjusted for clustering and relevant sociodemographic and impairment-related characteristics. Persons of ethnic minority backgrounds compared to NHW and persons of low versus high SES were significantly less likely to report full participation. Race and SES differences in the likelihood of participation were independent of neighborhood economic differences. Living in a disadvantaged neighborhood was associated with a lower likelihood of reporting optimal mobility and social integration.  These preliminary findings support the role of individual and contextual influences in the disabling process and suggest that persons with chronic disabilities from disadvantaged backgrounds and neighborhoods are more vulnerable to social exclusion.