Do Communities Matter After Rehabilitation? The Effect of Socioeconomic and Urban Stratification on Well-Being After Spinal Cord Injury

Abstract

Do communities matter after rehabilitation? The effect of socioeconomic and urban stratification on well-being after spinal cord injury. Objective To assess the influence of community-level socioeconomic status (SES) and urban composition on well-being after spinal cord injury (SCI) rehabilitation. Design Retrospective analysis of cross-sectional survey data. Setting Two participating centers in the SCI Model Systems (SCIMS) program. Participants Persons (N=1454) with traumatic SCI from New Jersey and Alabama enrolled in the SCIMS database in 2000 to 2009. Intervention Not applicable. Main Outcome Measures Dichotomous measures of perceived health (ill vs good health), life satisfaction (dissatisfied vs satisfied), and depressive symptoms (presence of a syndrome vs not) to assess well-being. Results Multilevel logistic regression was used to model community effects on each indicator of well-being. The likelihood of ill health and dissatisfaction with life in people with SCI, but not depressive symptoms, varied across communities. Community SES was related inversely to the odds of reporting ill health. However, the odds for dissatisfaction were higher in persons with SCI living in high SES and urban communities. Associations between community predictors and dissatisfaction with life were sustained after controlling for individual differences in injury severity, SES, and demographics, whereas individual SES was a stronger predictor of ill health than community SES. Conclusion This research suggests that community stratification influences the likelihood for diminished well-being for persons with SCI after rehabilitation. Understanding the contribution of communities in long-term outcomes after SCI rehabilitation is needed to inform future interventions aimed at preventing disability in this population.

The relationship between social determinants of health, and rehabilitation of neurological conditions: a systematic literature review

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Disability and the built environment: an investigation of community and neighborhood land uses and participation for physically impaired adults

“…For the analysis, age was dichotomized as under 55 and 55 years and above. An index of socioeconomic (SES) advantage used in prior research (45, 46) was created from six tract-level SES indicators (household income, home values, percentages residents with interest income, high school degrees, college degrees, and in high status occupations) extracted from five-year estimates from the American Community Survey released in 2011(47) and added as a proxy of individual SES.…”

Geographic variation in participation for physically disabled adults: The contribution of area economic factors to employment after spinal cord injury

“…Currently, 14 rehabilitation centers across the US are funded by the National Institute for Disability Research and Rehabilitation to collect data for the SCIMS program. With the approval of local institutional review boards, two of these centers—New Jersey and Alabama—collaborated to pilot the use of geographic identifiers to link individual outcomes data from the SCIMS database with area-level data from administrative databases (Botticello et al, 2011). …”

“…Several economic indicators were extracted from Census data: 1) the employment rate, 2) the percent of the population residing within an urban area, and 3) measures of household income (annual and interest income), housing values, education (high school and college completion), and the portion of residents employed in high status occupations combined to create an aggregate area-level socioeconomic index. This index was developed by Diez-Roux and colleagues (2001) and applied in various analyses of the relationship between community stratification and health (Botticello et al, 2011; Echeverria et al, 2008). The final standardized SES score had a mean of 0 and standard deviation of 1 for the 76 areas and a higher score corresponds with a higher level of SES.…”