Longitudinal Analysis of Hospitalization After Spinal Cord Injury: Variation Based on Race and Ethnicity

Published:August 02, 2014DOI:



      To examine the longitudinal effects of race/ethnicity on hospitalization among adults with spinal cord injury (SCI) in the 10-year period after initial injury.


      Retrospective analysis of postinjury hospitalizations among non-Hispanic white, non-Hispanic African American, and Hispanic adults with SCI.


      Community. Data were extracted from the 2011 National Spinal Cord Injury Model Systems database.


      Patients with traumatic SCI (N= 5146; white, 3175; African American, 1396; Hispanic, 575) who received rehabilitation at one of the relevant SCI Model Systems.


      Not applicable.

      Main Outcome Measures

      Hospitalization, including rate of hospitalization, number of hospitalizations, and number of days hospitalized during the 12 months before the first-, fifth-, and tenth-year follow-up interviews for the SCI Model Systems.


      Significant differences were found in rates of hospitalization at 1 and 5 years postinjury, with participants from Hispanic backgrounds reporting lower rates than either whites or African Americans. At 10 years postinjury, no differences were noted in the rate of hospitalization between racial/ethnic groups; however, compared with whites (P=.011) and Hispanics (P=.051), African Americans with SCI had 13 and 16 more days of hospitalization, respectively. Compared with the first year postinjury, the rate of hospitalization declined over time among whites, African Americans, and Hispanics; however, for African Americans, the number of days hospitalized increased by 12 days (P=.036) at 10 years versus 5 years postinjury.


      Racial/ethnic variation appears to exist in postinjury hospitalization for individuals with SCI, with Hispanics showing the lowest rates of hospitalization at 1 and 5 years postinjury and African Americans having a significantly higher number of days hospitalized at 10 years postinjury. Potential explanations for these variations are discussed, and recommendations are made for potential changes to policy and clinical care.


      List of abbreviations:

      CI (confidence interval), LOS (length of stay), SCIMS (Spinal Cord Injury Model Systems), SCI (spinal cord injury)
      To read this article in full you will need to make a payment


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Spinal cord injury facts and figures at a glance. National Spinal Cord Injury Statistical Center, Birmingham2012
        • Krause J.S.
        • Saladin L.K.
        • Adkins R.H.
        Disparities in subjective well-being, participation, and health after spinal cord injury: a 6-year longitudinal study.
        NeuroRehabilitation. 2009; 24: 47-56
        • Krause J.S.
        • Saunders L.L.
        Health, secondary conditions, and life expectancy after spinal cord injury.
        Arch Phys Med Rehabil. 2011; 92: 1770-1775
        • Pickelsimer E.
        • Shiroma E.J.
        • Wilson D.A.
        Statewide investigation of medically attended adverse health conditions of persons with spinal cord injury.
        J Spinal Cord Med. 2010; 33: 221-231
        • Davidoff G.
        • Schultz S.
        • Lieb T.
        • et al.
        Rehospitalization after initial rehabilitation for acute spinal cord injury: incidence and risk factors.
        Arch Phys Med Rehabil. 1990; 71: 121-124
        • Eastwood E.A.
        • Hagglund K.J.
        • Ragnarsson K.T.
        • Gordon W.A.
        • Marino R.J.
        Medical rehabilitation length of stay and outcomes for persons with traumatic spinal cord injury 1990-1997.
        Arch Phys Med Rehabil. 1999; 80: 1457-1463
        • Ivie C.
        • DeVivo M.
        Predicting unplanned hospitalizations in persons with spinal cord injury.
        Arch Phys Med Rehabil. 1994; 75: 1182-1188
        • Krause J.S.
        • Saunders L.L.
        Risk of hospitalizations after spinal cord injury: relationship with biographical, injury, educational, and behavioral factors.
        Spinal Cord. 2009; 47: 692-697
        • Cardenas D.D.
        • Hoffman J.M.
        • Kirshblum S.
        • McKinley W.
        Etiology and incidence of rehospitalization after traumatic spinal cord injury: a multicenter analysis.
        Arch Phys Med Rehabil. 2004; 85: 1757-1763
        • Meyers A.R.
        • Feltin M.
        • Master R.J.
        • et al.
        Rehospitalization and spinal cord injury: cross-sectional survey of adults living independently.
        Arch Phys Med Rehabil. 1985; 66: 704-708
        • Dryden D.M.
        • Saunders L.D.
        • Rowe B.H.
        • et al.
        Utilization of health services following spinal cord injury: a 6-year follow-up study.
        Spinal Cord. 2004; 42: 513-525
        • 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
        • Gary K.W.
        • Nicholls E.
        • Shamburger A.
        • Stevens L.F.
        • Arango-Lasprilla J.C.
        Do racial and ethnic minority patients fare worse after SCI?: a critical review of the literature.
        NeuroRehabilitation. 2011; 29: 275-293
        • Krause J.
        • Broderick L.
        • Saladin L.
        • Broyles J.
        Racial disparities in health outcomes after spinal cord injury: mediating effects of education and income.
        J Spinal Cord Med. 2006; 29: 17-25
        • Arango-Lasprilla J.C.
        • Ketchum J.M.
        • Francis K.
        • Premuda P.
        • Stejskal T.
        • Kreutzer J.
        Influence of race/ethnicity on divorce/separation 1, 2, and 5 years post spinal cord injury.
        Arch Phys Med Rehabil. 2009; 90: 1371-1378
        • Meade M.A.
        • Lewis A.
        • Jackson M.N.
        • Hess D.W.
        Race, employment, and spinal cord injury.
        Arch Phys Med Rehabil. 2004; 85: 1782-1792
        • Humes K.R.
        • Jones N.A.
        • Ramirez R.R.
        Overview of race and Hispanic origin: 2010.
        US Census Bureau, SuitlandMarch 2011
        • National Spinal Cord Injury Statistical Center
        The Spinal Cord Injury Model Systems’ data dictionary for the National Spinal Cord Injury database 2011-2016, V 10.
        National Spinal Cord Injury Statistical Center, Birmingham2013
        • McCulloch C.E.
        Generalized linear mixed models. Encyclopedia of environmetrics.
        John Wiley & Sons, Hoboken2006
      2. Schabenberger O. Introducing the GLIMMIX procedure for generalized linear mixed models 2005. 196-30. Available at: Accessed January 14, 2014.

        • Verbeke G.
        • Molenberghs G.
        Linear mixed models for longitudinal data.
        Springer, New York2009
      3. Deb P, Manning W, Norton E. Modeling health care costs and counts 2012. Available at: Accessed January 14, 2014.

        • Krause J.S.
        • DeVivo M.J.
        • Jackson A.B.
        Health status, community integration, and economic risk factors for mortality after spinal cord injury.
        Arch Phys Med Rehabil. 2004; 85: 1764-1773
        • Sabogal F.
        • Marín G.
        • Otero-Sabogal R.
        • Marín B.V.
        • Perez-Stable E.J.
        Hispanic familism and acculturation: what changes and what doesn't?.
        Hisp J Behav Sci. 1987; 9: 397-412
        • Zea M.C.
        • Quezada T.
        • Belgrave F.Z.
        Latino cultural values: their role in adjustment to disability.
        J Soc Behav Pers. 1994; 9: 185-200
        • Starfield B.
        • Shi L.
        The medical home, access to care, and insurance: a review of evidence.
        Pediatrics. 2004; 113: 1493-1498
        • Barczak C.A.
        • Barnett R.I.
        • Childs E.J.
        • Bosley L.M.
        Fourth national pressure ulcer prevalence survey.
        Adv Wound Care. 1997; 10: 18-26
        • Mahmoudi E.
        • Jensen G.A.
        Diverging racial and ethnic disparities in access to physician care: comparing 2000 and 2007.
        Med Care. 2012; 50: 327
        • Mahmoudi E.
        • Jensen G.A.
        Exploring disparities in access to physician services among older adults: 2000–2007.
        J Gerontol B Psychol Sci Soc Sci. 2013; 68: 128-138