Racial and Ethnic Disparities in Social Determinants of Health and Health Outcomes in Individuals with Traumatic Spinal Cord Injury: A Scoping Review

OBJECTIVE: To map the existing literature and identify gaps related to racial and ethnic disparities in social determinants of health (SDOH) and health outcomes among individuals with traumatic spinal cord injury (tSCI) in the United States. DATA SOURCES: PubMed, Embase, CINAHL, Scopus, and Web of Science databases were searched for English-language journals up until April 2024. Reference lists of eligible articles were also screened. STUDY SELECTION: A total of 5,893 records were screened by title and abstract by two pairs of independent reviewers. Two reviewers independently assessed the remaining 549 records using predetermined exclusion and inclusion criteria. DATA EXTRACTION: SDOH outcomes were classified into five categories using the Healthy People 2030 framework: economic stability, healthcare access and quality, neighborhood environment, education access and quality, and social and community context. Health outcomes were grouped into conceptually related categories based on the primary outcomes (e.g., functional independence, mental, bowel/bladder, and metabolic health). DATA SYNTHESIS: Of the 549 studies screened via full-text review, 143 were included in the final synthesis. Across the literature, racial and ethnic differences are described in every SDOH domain and in several clinical outcomes, although the volume and quality of supporting evidence vary. Studies often report that minoritized people with tSCI face lower employment rates and wages, more discrimination in healthcare settings, and are more likely to live in socio-economically disadvantaged neighborhoods. Health-related publications frequently note lower functional independence, higher rates of secondary complications, and reduced quality of life for these groups. CONCLUSIONS: The scoping review revealed racial and ethnic inequities in SDOH and health outcomes among individuals with tSCI in existing literature. Future in-depth investigations are necessary to understand the drivers of these disparities and to inform effective strategies for addressing them.