All ETDs from UAB

Advisory Committee Chair

Yuying Chen

Advisory Committee Members

C Scott Bickel

Andrea Cherrington

Kevin Fontaine

Tapan Mehta

Document Type

Dissertation

Date of Award

2019

Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions

Abstract

People with disabilities are 1.5-2.5 times more likely to be obese than those without disabling conditions. We have learned a lot about obesity in the general population. However, the neurological deficits of people with spinal cord injury (SCI) make it difficult to generalize the findings in the general population to the SCI population. Therefore, the purposes of this dissertation were to 1) assess racial differences in body mass index (BMI) change over 5 years; 2) evaluate the role of neighborhood in the relationship between race and obesity; 3) examine the impact of BMI at the time of injury on 1-year mortality, by analyzing data from the National SCI Model Systems Database. Among 437 participants in the first study, Hispanics had the greatest BMI increase (2.0±5.7kg/m2) among those with severe injuries, those who were underweight or of normal weight at baseline, and those within 10 years of their injury. In the second study of 3,385 participants, Hispanics had the highest obesity prevalence (67.0%). Although disadvantaged neighborhood was strongly related to race and obesity, the odds of being obese in Hispanics relative to non-Hispanic whites decreased from 1.67 to 1.51, after accounting for concentrated disadvantaged index. In the third study of 6,640 participants who survived the first 90 days after SCI, the adjusted hazard ratio for 1-year mortality in people with obesity was 1.59 as compared those with normal weight, after adjusting for demographic and injury-related factors. From those studies, we found Hispanics are more likely to gain weight after injury and have a higher prevalence of obesity which is partially diminish by disadvantaged neighborhood, when compared with other racial groups. Those findings may help to target the risk group for weight management and also provide a foundation for future research to explore risk and protective factors that contribute to racial differences in obesity after SCI. Additionally, we conclude that people who are obese at the time of injury tend to have a higher mortality rate during year 1 after injury. Future studies should explore the factors that contribute to higher death rate of those with obesity, such preexisting conditions and comorbidities.

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