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

Objective: 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. The second aim was to determine whether racial or ethnic disparities of technology use were experienced. Design: 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: Participants included were at least 1-year posttraumatic tetraplegia injury and participated in NSCIMS between 2011 and 2016 (N=3096). Setting: NSCIMS observational data were originally collected via in-person or phone interviews. Interventions: Not applicable. Main Outcome Measure(s): A binary logistic regression was conducted to determine whether self-reported use of computers or similar device, the internet, computer AT, race, ethnicity, and other demographics predicted high (≥80) vs low/medium (<80) social participation, measured by the Craig Handicap and Reporting Technique social integration standardized measure. Results: Combined use of a computer, AT, and the internet predicted greater social integration by almost 175% (95% confidence interval [CI], 2.0-3.78; P<.001) compared with no device or internet use. Racial and ethnic disparities were discovered. Black participants had 28% lower odds of high social integration than White participants (95% CI, 0.56-0.92; P<.01). Hispanic ethnicity predicted 40% lower odds of high social integration compared with non-Hispanic participants (95% CI, 0.39-0.91; P=.018). Conclusions: 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.