To what extent do neighborhood differences mediate racial disparities in participation after spinal cord injury?

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Study investigated the contribution of residential neighborhood characteristics to race disparities in participation among community-living adults with chronic spinal cord injury (SCI). Survey data from the SCI Model Systems (SCIMS) database were linked with residential characteristics derived from national survey and spatial data to assess the contribution of social, economic, and physical neighborhood characteristics to race disparities in community participation after SCI. The sample consisted of 6,892 SCIMS database participants in 5,441 Census tracts from 50 states and the District of Columbia. The Craig Handicap Assessment and Reporting Technique was used to measure participation across 4 domains: physical independence, mobility, occupation, and social integration. Results indicated that racial minority groups had lower odds of reporting full participation relative to Whites across all domains, suggesting that Blacks and Hispanics are at risk for poorer community reintegration after SCI. Neighborhood characteristics, notably differences in socioeconomic advantage, reduced race group differences in the odds of full occupational and social integration, suggesting that the race disparities in community reintegration after SCI are partially attributable to variation in the economic characteristics of the places where people live. Findings suggest that addressing disadvantage at the neighborhood level may modify gaps in community participation after medical rehabilitation and provide further support for the role of the environment in the experience of disability.

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