ORIGINAL ARTICLE Longitudinal Analysis of Hospitalization After Spinal Cord Injury: Variation Based on Race and Ethnicity Elham Mahmoudi, PhD, MS, a Michelle A. Meade, PhD, b Martin B. Forchheimer, MPP, b Denise C. Fyffe, PhD, c James S. Krause, PhD, d Denise Tate, PhD b From the a Department of Surgery, University of Michigan Medical School, Ann Arbor, MI; b Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI; c Kessler Foundation Research Center, West Orange, NJ; and d Medical University of South Carolina, Charleston, SC. Abstract Objective: To examine the longitudinal effects of race/ethnicity on hospitalization among adults with spinal cord injury (SCI) in the 10-year period after initial injury. Design: Retrospective analysis of postinjury hospitalizations among non-Hispanic white, non-Hispanic African American, and Hispanic adults with SCI. Setting: Community. Data were extracted from the 2011 National Spinal Cord Injury Model Systems database. Participants: Patients with traumatic SCI (NZ 5146; white, 3175; African American, 1396; Hispanic, 575) who received rehabilitation at one of the relevant SCI Model Systems. Interventions: Not applicable. Main Outcome Measures: Hospitalization, including rate of hospitalization, number of hospitalizations, and number of days hospitalized during the 12 months before the first-, fifth-, and tenth-year follow-up interviews for the SCI Model Systems. Results: Significant differences were found in rates of hospitalization at 1 and 5 years postinjury, with participants from Hispanic backgrounds reporting lower rates than either whites or African Americans. At 10 years postinjury, no differences were noted in the rate of hospitalization between racial/ethnic groups; however, compared with whites (PZ.011) and Hispanics (PZ.051), African Americans with SCI had 13 and 16 more days of hospitalization, respectively. Compared with the first year postinjury, the rate of hospitalization declined over time among whites, African Americans, and Hispanics; however, for African Americans, the number of days hospitalized increased by 12 days (PZ.036) at 10 years versus 5 years postinjury. Conclusions: Racial/ethnic variation appears to exist in postinjury hospitalization for individuals with SCI, with Hispanics showing the lowest rates of hospitalization at 1 and 5 years postinjury and African Americans having a significantly higher number of days hospitalized at 10 years postinjury. Potential explanations for these variations are discussed, and recommendations are made for potential changes to policy and clinical care. Archives of Physical Medicine and Rehabilitation 2014;95:2158-66 ª 2014 by the American Congress of Rehabilitation Medicine Spinal cord injury (SCI) is one of the most devastating and expen- sive traumatic events that typically results in a chronic condition. There are approximately 270,000 people living with SCI in the United States. 1 Personal costs of SCI are estimated to be $334,170 to $1,023,924 during the first year postinjury, and $40,589 to $177,808 in each subsequent year. 1 Because more than half of all individuals with SCI do not have private health insurance, 2 the economic con- sequences of living with SCI have significant impacts on those in- dividuals’ lives and on the public support system. Individuals with SCI are more likely than those without to develop severe medical complications that lead to hospitaliza- tions. 3 Research shows that over a 10-year period, 93% of Presented in part to the Michigan Academy of Art and Science, February 28, 2014, Auburn Hills, MI. Supported by the Department of Education, National Institute on Disability and Rehabilitation Research (grant no. H133P090008), and by the National Institute on Disability and Rehabilitation Advanced Rehabilitation Research Training Project (grant no. H133N11002). Disclosures: none. 0003-9993/14/$36 - see front matter ª 2014 by the American Congress of Rehabilitation Medicine http://dx.doi.org/10.1016/j.apmr.2014.07.399 Archives of Physical Medicine and Rehabilitation journal homepage: www.archives-pmr.org Archives of Physical Medicine and Rehabilitation 2014;95:2158-66