Race, Ethnicity, and Employment Outcomes 1, 5, and 10 Years After Spinal Cord Injury: A Longitudinal Analysis

Objectives (1) To compare the odds of competitive employment versus not competitive employment among a group of white, African American, and Hispanic persons with spinal cord injury (SCI) at 1, 5, and 10 years after injury; (2) to examine the changes in the odds of competitive employment versus not competitive employment over time within each racial/ethnic group, and (3) to compare the changes in the odds of competitive employment versus not competitive employment over time between the racial/ethnic groups. Design Retrospective study. Setting Model SCI systems. Participants A total of 11,090 persons with SCI (7735 whites, 2381 African Americans, and 974 Hispanics), between ages 18 and 55 years, enrolled in the National Spinal Cord Injury Statistical Center database. Main Outcome Measure Employment status dichotomized as competitively employed versus not competitively employed. Results The odds of being competitively employed at 1, 5, and 10 years after injury were 1.58, 2.55, and 3.02, times greater for whites than African Americans and 1.71, 1.86, and 1.71, respectively, times greater for whites than Hispanics. At 10 years after injury, the odds of being competitively employed were 1.77 times greater for Hispanics than for African Americans. Persons of all races/ethnicities and with SCI showed significantly greater increases in the odds of being competitively employed versus not competitively employed over time (1-5 years, 1-10 years, 5-10 years after injury); however, whites and Hispanics had greater increases in the odds of competitive employment over time compared with African Americans. Conclusions Regardless of race, short- and long-term employment outcomes were not favorable for persons with SCI; however, African Americans and Hispanics fared worse in employment outcomes compared with whites. Rehabilitation professionals should work to improve employment outcomes for all individuals with SCI, with special emphasis on addressing specific needs of African Americans and Hispanics.