Impact of Patient Race on Morbidity and Mortality in Adults with Acute Traumatic Cervical Spinal Cord Injury

Introduction: Racial disparities in spine surgery have been associated with adverse outcomes, however the impact of race on outcomes of patients with spinal cord injury (SCI) is understudied. The aim of this study was to investigate the association of race with morbidity and mortality in patients with acute, cervical SCI.

Methods: We conducted a retrospective cohort study using the American College of Surgeons Trauma Quality Programs (TQP) database to compare outcomes for adults with acute, cervical SCI between race and ethnicity groups: non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic or Latino (HIS), and other (OTH). Patient demographics, comorbidities, injury type, treatment modality, and adverse events (AEs) were assessed. Multivariate logistic regression was used to identify independent predictors of AEs, non-routine discharge (NRD), and in-hospital mortality.

Results: Of the 71,048 patients, 44,639 (62.8%) were NHW-identifying, 13,555 (19.1%) were NHB-identifying, 5,820 (8.2%) were HIS-identifying, and 7,034 (9.9%) were OTH-identifying. NHB- and HIS-identifying patients had the greatest rates of any AE (NHW: 20.7% vs. NHB: 25.0% vs. HIS: 24.6% vs. OTH: 22.0%, p< 0.001) and the longest mean length of stay (NHW: 11.3 ± 13.5 days vs. NHB: 15.5 ± 20.2 days vs. HIS: 15.0 ± 20.5 days vs. OTH: 12.6 ± 17.5 days, p< 0.001). NRD rates were lowest for HIS-identifying patients (NHW: 74.8% vs. NHB: 75.5% vs. HIS: 69.5% vs. OTH: 75.4%, p< 0.001), while in-hospital mortality was lowest for NHB-identifying patients (NHW: 12.8% vs. NHB: 10.1% vs. HIS: 12.4% vs. OTH: 13.4%, p< 0.001). On multivariate analyses, only HIS (Odds Ratio (OR): 1.15; Confidence Interval (CI): 1.01-1.32; p=0.037) and OTH identities (OR: 1.15; CI: 1.02-1.30; p=0.026) were significant predictors of AEs. NHB race was significantly associated with increased odds (OR: 1.25; CI: 1.13-1.38; p< 0.001), while HIS race was significantly associated with decreased odds (OR: 0.77; CI: 0.67-0.89; p< 0.001) of NRD. Only NHB race was significantly associated with decreased odds of in-hospital mortality (OR: 0.66; CI: 0.59-0.74; p< 0.001).

Conclusion : Our study suggests racial disparities in outcomes and discharge disposition of patients undergoing treatment for acute, cervical SCI. Further research is needed to identify and address factors contributing to these racial disparities.