Original Research|Articles in Press

Racial and Ethnic Disparities of Social Participation After Tetraplegia Injury: A Regression Analysis

Published:March 06, 2023DOI:



      The first aim of this study was to determine whether the use of computers, internet, and computer assistive technology (AT) increased social participation after tetraplegia spinal cord injury (SCI). The second aim was to determine if racial or ethnic disparities of technology use was experienced.


      A secondary analysis of data collected by the National Spinal Cord Injury Models Systems Study (NSCIMS), an ongoing observational cohort study, was performed on a sample of 3096 participants who experienced a traumatic tetraplegic injury.


      Participants included were at least 1-year post traumatic tetraplegia injury and participated in NSCIMS between 2011–2016 (N = 3096).


      NSCIMS observational data was originally collected via in-person or phone interviews.


      Not applicable.

      Main Outcome Measure(s)

      A binary logistic regression was conducted to determine if self-reported use of computers or similar device, the internet, computer AT, race, ethnicity, and other demographics predicted high (≥ 80) versus low/medium (< 80) social participation, measured by the Craig Handicap and Reporting Technique (CHART) social integration standardized measure.


      Combined use of a computer, AT, and the internet predicted higher social integration by almost 175% (95% CI [2.0, 3.78]; p < .001) compared to no device or internet use. Racial and ethnic disparities were discovered. Black participants had 28% lower odds of high social integration than White participant (95% CI [0.56, 0.92]; p < .01). Hispanic ethnicity predicted 40% lower odds of high social integration compared to non-Hispanic participants (95% CI [0.39, 0.91]; p = .018).


      The internet presents an opportunity to reduce barriers to social participation and increase overall social integration after tetraplegia. However, race, ethnic, and income inequities prevent or limit access to the internet, computers, and AT after tetraplegia for Black and Hispanic people.


      List of abbreviations:

      AIS (American Spinal Injury Association Impairment Scale), AT (Assistive Technology), Craig Handicap and Reporting Technique (CHART), NSCIMS (National Spinal Cord Injury Model Systems), NSCISC (National Spinal Cord Injury Statistical Center), OR (Odds ratio), SCI (Spinal Cord Injury)
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