Examining inequalities in people with spinal cord injury through functioning

BACKGROUND: Socioeconomic disparities are a persistent determinant of health outcomes, yet limited research has explored how income affects the overall functioning of individuals with spinal cord injury (SCI). OBJECTIVE: To examine the relationship between income and health in individuals with spinal cord injury (SCI), using functioning as a broader health measure. METHODS: This study analyzed income-related health disparities across income groups in individuals with traumatic SCI from ten countries, using cross-sectional data from the first Internal Spinal Cord Injury Survey (InSCI) and related studies (2017-2019). Functioning was assessed with the brief International Classification of Functioning, Disability and Health (ICF) core set for SCI. Income was categorized using general population income deciles for comparability. RESULTS: Lower-income individuals with SCI had poorer functioning than higher-income groups. The disparity in functioning scores between the highest and lowest income groups ranged from 3 to 14 points, with China showing the largest gap (11 points) and France and Switzerland the smallest (2 and 4 points, respectively). In South Korea, functioning scores were below 40 across all income groups. Age at injury onset significantly influenced disparities, with the greatest gaps among working-age individuals and, in some countries, older adults. CONCLUSION: Income-based income-related health disparities are evident in individuals with SCI, with lower income consistently linked to reduced functioning. The findings emphasize the need to address economic and age-related factors in SCI health interventions across diverse national contexts.