Association of Race, Socioeconomic Status, and Health Care Access With Pressure Ulcers After Spinal Cord Injury

Published:February 15, 2012DOI:


      Saunders LL, Krause JS, Acuna J. Association of race, socioeconomic status, and health care access with pressure ulcers after spinal cord injury.


      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).




      Large specialty hospital in the southeastern United States.


      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).



      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).


      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.


      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.

      Key Words

      List of Abbreviations:

      BRFSS (Behavioral Risk Factor Surveillance System), CI (confidence interval), OR (odds ratio), PU (pressure ulcer), SCI (spinal cord injury), SES (socioeconomic status)
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        • Johnson R.L.
        • Gerhart K.A.
        • McCray J.
        • Menconi J.C.
        • Whiteneck G.G.
        Secondary conditions following spinal cord injury in a population-based sample.
        Spinal Cord. 1998; 36: 45-50
        • Javitz H.S.
        • Ward M.M.
        • Martens L.
        Major costs associated with pressure sores.
        J Wound Care. 1998; 7: 286-290
        • Krause J.S.
        • Zhai Y.
        • Saunders L.L.
        • Carter R.E.
        Risk of mortality after spinal cord injury: an 8-year prospective study.
        Arch Phys Med Rehabil. 2009; 90: 1708-1715
        • Saladin L.S.
        • Krause J.S.
        • Adkins R.H.
        Pressure ulcer prevalence and barriers to treatment after spinal cord injury: comparisons of 4 groups based on race-ethnicity.
        NeuroRehabil. 2009; 24: 57-66
        • Chen Y.
        • Devivo M.J.
        • Jackson A.B.
        Pressure ulcer prevalence in people with spinal cord injury: age-period-duration effects.
        Arch Phys Med Rehabil. 2005; 86: 1208-1213
        • Saunders L.L.
        • Krause J.S.
        • Peters B.A.
        • Reed K.S.
        The relationship of pressure ulcers, race, and socioeconomic conditions after spinal cord injury.
        J Spinal Cord Med. 2010; 33: 387-395
        • DeVivo M.J.
        • Stover S.L.
        • Fine P.R.
        The relationship between sponsorship and rehabilitation outcome following spinal cord injury.
        Paraplegia. 1989; 27: 470-479
        • Tate D.G.
        • Forchheimer M.
        • Daugherty J.
        • Maynard F.
        Determining differences in post discharge outcomes among catastrophically and noncatastrophically sponsored outpatients with spinal cord injury.
        Am J Phys Med Rehabil. 1994; 73: 89-97
        • Tate D.G.
        • Stiers W.
        • Daugherty J.
        • Forchheimer M.
        • Cohen E.
        • Hansen N.
        The effects of insurance benefits coverage on functional and psychosocial outcomes after spinal cord injury.
        Arch Phys Med Rehabil. 1994; 75: 407-414
        • Kroll T.
        • Neri M.T.
        • Ho P.S.
        Secondary conditions in spinal cord injury: results from a prospective survey.
        Disabil Rehabil. 2007; 29: 1229-1237
        • Krause J.S.
        • Reed K.S.
        • McArdle J.J.
        A structural analysis of health outcomes after spinal cord injury.
        J Spinal Cord Med. 2010; 33: 22-32
        • Bennett M.A.
        Report of the task force on the implications for darkly pigmented intact skin in the prediction and prevention of pressure ulcers.
        Adv Wound Care. 1995; 8: 34-35
        • Krause J.S.
        • Carter R.E.
        • Pickelsimer E.
        • Wilson D.
        A prospective study of health and risk of mortality after spinal cord injury.
        Arch Phys Med Rehabil. 2008; 89: 1482-1491
        • Centers for Disease Control and Prevention
        1996 Behavioral Risk Factor Questionnaire.
        (Accessed February 21, 2012)
        • Hosmer D.W.
        • Lemeshow S.
        Applied logistic regression.
        2nd ed. John Wiley and Sons, New York2000
        • Hunt P.C.
        • Boninger M.L.
        • Cooper R.A.
        • Zafonte R.D.
        • Fitzgerald S.G.
        • Schmeler M.R.
        Demographic and socioeconomic factors associated with disparity in wheelchair customizability among people with traumatic spinal cord injury.
        Arch Phys Med Rehabil. 2004; 85: 1859-1864
        • Sprigle S.
        • Chung K.C.
        • Brubaker C.E.
        Reduction of sitting pressures with custom contoured cushions.
        J Rehabil Res Dev. 1990; 27: 135-140
        • Garber S.L.
        • Rintala D.H.
        Pressure ulcers in veterans with spinal cord injury: a retrospective study.
        J Rehabil Res Dev. 2003; 40: 433-442
        • Baumgarten M.
        • Margolis D.
        • van Doorn C.
        • et al.
        Black/white differences in pressure ulcer incidence in nursing home residents.
        J Amer Geri Soc. 2004; 52: 1293-1298
        • Lyder C.H.
        • Yu C.
        • Emerling J.
        • et al.
        The Braden Scale for pressure ulcer risk: evaluating the predictive validity in Black and Latino/Hispanic elders.
        Appl Nurs Res. 1999; 12: 60-68
        • Garber S.L.
        • Rintala D.H.
        • Hart K.A.
        • Fuhrer M.J.
        Pressure ulcer risk in spinal cord injury: predictors of ulcer status over 3 years.
        Arch Phys Med Rehabil. 2000; 81: 465-471