Association of race, socioeconomic status, and health care access with pressure ulcers after spinal cord injury

Arch Phys Med Rehabil. 2012 Jun;93(6):972-7. doi: 10.1016/j.apmr.2012.02.004. Epub 2012 Apr 10.


Objective: To assess the associations of race and socioeconomic status (SES) with pressure ulcers (PUs) after accounting for health care access among persons with spinal cord injury (SCI).

Design: Cross-sectional.

Setting: Large specialty hospital in the southeastern United States.

Participants: Persons with traumatic SCI who (1) had residual effects from their injury, (2) were 18 years or older at the time of the survey, and (3) were a year or more postinjury at the time of survey (N=2549).

Interventions: None.

Main outcome measures: Outcomes were measured by a mail-in survey: having a current PU (yes vs no), having a PU in the past year with or without reduced sitting time (no PU, no reduced sitting time, month or less, ≥5wk), and having at least 1 PU surgery since SCI onset (yes vs no).

Results: 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. While race was preliminarily associated with each PU outcome, it became nonsignificant after controlling for SES and health care access. 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 health care access factors. Persons with lower income had higher odds of each PU outcome. Health care access was not consistently related to PU outcomes.

Conclusions: Even after accounting for health care access, household income, a measure of SES, remained significantly associated with PU outcomes after SCI; however, race became nonsignificant.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Age Distribution
  • Comorbidity
  • Confidence Intervals
  • Continental Population Groups / statistics & numerical data*
  • Cross-Sectional Studies
  • Female
  • Follow-Up Studies
  • Health Services Accessibility / statistics & numerical data*
  • Humans
  • Incidence
  • Injury Severity Score
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Paraplegia / diagnosis
  • Paraplegia / epidemiology
  • Paraplegia / rehabilitation
  • Pressure Ulcer / diagnosis*
  • Pressure Ulcer / epidemiology*
  • Pressure Ulcer / therapy
  • Quadriplegia / diagnosis
  • Quadriplegia / epidemiology
  • Quadriplegia / rehabilitation
  • Risk Assessment
  • Sex Distribution
  • Social Class*
  • Spinal Cord Injuries / diagnosis
  • Spinal Cord Injuries / epidemiology*
  • Spinal Cord Injuries / rehabilitation
  • Surveys and Questionnaires
  • United States / epidemiology