Associations Between Functioning Recovery, Employment, and Neighborhood Disadvantage in People With Spinal Cord Injury

Abstract

Research Objectives To examine the association of neighborhood disadvantage and healthcare utilization, physical independence, mobility, social participation, and return to work (RTW) in individuals with spinal cord injury (SCI). Design A cohort study using the National Spinal Cord Injury (SCI) Model Systems Database linked with Area Deprivation Index (ADI) percentile scores from the Neighborhood Atlas by census block.Setting: Seventeen SCI Model Systems centers across the United States. Participants A total of 5094 individuals with traumatic SCI were discharged from rehabilitation programs between November 2011 and July 2020 and completed 1-year follow-up interviews. Interventions None. Main Outcome Measures One-year healthcare utilization, measured by whether participants rehospitalization, and physical independence, mobility, and social integration measured using the Craig Handicap Assessment and Reporting Technique (CHART). Multivariable logistic regression models were used to examine the associations. Results After adjusting for demographic, injury-related characteristics, and pre-injury comorbidity, neighborhood disadvantage was not associated with hospital readmission. However, compared with SCI individuals who live in the least disadvantaged neighborhood, those who live in the most disadvantaged neighborhood had a lower physical independence (need paid or unpaid assistant: OR[CI]= 1.52 [1.04-2.23]), mobility (day out of house: 0.38 [0.26 - 0.55]; night away from house: 0.44[0.36-0.62]), social integration (conversation with friends: 0.46 [0.33-0.63]; conversation with Stranger:0.57[0.41-0.80]), and RTW (0.18 [0.09-0.34]). Conclusions Neighborhood disadvantage was negatively associated with physical independence, mobility, social participant and RTW in individuals with SCI. Additional research is needed to identify potentially modifiable factors that may reduce inequalities in outcomes in the SCI population. Author(s) Disclosures no conflicts of interest in disclosures. To examine the association of neighborhood disadvantage and healthcare utilization, physical independence, mobility, social participation, and return to work (RTW) in individuals with spinal cord injury (SCI). A cohort study using the National Spinal Cord Injury (SCI) Model Systems Database linked with Area Deprivation Index (ADI) percentile scores from the Neighborhood Atlas by census block.Setting: Seventeen SCI Model Systems centers across the United States. A total of 5094 individuals with traumatic SCI were discharged from rehabilitation programs between November 2011 and July 2020 and completed 1-year follow-up interviews. None. One-year healthcare utilization, measured by whether participants rehospitalization, and physical independence, mobility, and social integration measured using the Craig Handicap Assessment and Reporting Technique (CHART). Multivariable logistic regression models were used to examine the associations. After adjusting for demographic, injury-related characteristics, and pre-injury comorbidity, neighborhood disadvantage was not associated with hospital readmission. However, compared with SCI individuals who live in the least disadvantaged neighborhood, those who live in the most disadvantaged neighborhood had a lower physical independence (need paid or unpaid assistant: OR[CI]= 1.52 [1.04-2.23]), mobility (day out of house: 0.38 [0.26 - 0.55]; night away from house: 0.44[0.36-0.62]), social integration (conversation with friends: 0.46 [0.33-0.63]; conversation with Stranger:0.57[0.41-0.80]), and RTW (0.18 [0.09-0.34]). Neighborhood disadvantage was negatively associated with physical independence, mobility, social participant and RTW in individuals with SCI. Additional research is needed to identify potentially modifiable factors that may reduce inequalities in outcomes in the SCI population.