Racial/ethnic disparities in outcomes after central nervous system injury.

People from racial/ethnic minority groups currently make up 33% of the population in the United States [18]. This percentage has increased dramatically over the past 10 years [11]. The US minority population will continue to grow, and it is predicted that by 2050, minorities may constitute up to 49% of the country’s total population. In particular, the Hispanic population is increasing rapidly and now constitutes the largest minority group in the US. Research from the early 1990’s suggests that compared to their Caucasian counterparts, minorities may be more vulnerable to suffer central nervous systems injuries such as traumatic brain injury (TBI) [7,8,12], spinal cord injury (SCI) [9] and stroke [6,10]. The growth of the US minority population,combined with possible increased vulnerability to TBI, SCI, and stroke, have created numerous challenges for rehabilitation professionals of the 21st century. Fairly recently, researchers have begun to pay attention to the influence of race/ethnicity on healthcare delivery, receipt, and subsequent outcomes [16,17]. Various disparities have been identified in the literature, and most of the articles included in this issue focus on racial/ethnic differences post-injury in employment, life satisfaction, community integration, health, and well-being outcomes. Furthermore, given the specific growth of the Hispanic population, professionals in the field are recognizing the need for valid neuropsychological assessment tools for Spanish speakers. Specifically, the proposed “culture-free” nature of neuropsychological testing has been questioned in recent years, and researchers and clinicians alike have doubted the validity of literal translations of English-language assessment tools for use with non-English speakers [5,15]. Inaccurate diagnosis leads to inappropriate intervention, and it is possible that the use of inadequate evaluation instruments may contribute to disparities in outcomes. Therefore, in this issue, two articles describe instruments that are valid for use with the Spanish-speaking population. A brief overview of all the feature articles will follow. Three articles document racial/ethnic disparities in life satisfaction or community integration after TBI. The article by Arango-Lasprilla and colleagues studied racial differences in life satisfaction at 1-year postinjury among 2478 Caucasian, 629 African American, 180 Hispanic, and 81 Asian/Pacific islander individuals with primarily moderate to severe TBI who were part of the Traumatic Brain Injury Model Systems database. African-Americans reported poorer life satisfaction than Caucasians and Asians, even after controlling for marital status, employment at admission, cause of the injury, functional independence at discharge, and length of stay in acute care. Sander and colleagues sought to determine the contribution of race/ethnicity and income to community integration at approximately 6 months following TBI. The sample was made up 151 individuals with mild to severe TBI (38% African Americans; 38% Hispanics; and 24% Caucasians) recruited from consecutive admissions to the neurosurgery service of a county Level I trauma center. Results showed that, after accounting for injury severity, age, education, and income, race/ethnicity contributed significantly to the variance in the Community Integration Questionniare total score, as well as the Home Integration Sub-scale and Productive Activity Sub-scale scores. Finally, Mascialino and colleagues examined disparities in objective and subjective components of community integration beyond 1 year postinjury in a group of 360 community dwelling adults with TBI (254 Caucasians and 106 minorities). For objective indicators, White participants reported using less transportation services than minorities, after controlling for demographic and injury variables. For subjective indicators, Whites were significantly less dis-