Do communities matter after rehabilitation? The effect of socioeconomic and urban stratification on well-being after spinal cord injury

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Study assessed the influence of community-level socioeconomic status (SES) and urban composition on well-being after spinal cord injury (SCI) rehabilitation. Data were obtained from 1,454 patients with traumatic SCI from two centers participating centers in the SCI Model Systems program. Dichotomous measures of perceived health (ill versus good health), life satisfaction (dissatisfied versus satisfied), and depressive symptoms (presence of a syndrome versus not) were used to assess well-being. Multilevel logistic regression was used to model community effects on each indicator of well-being. Results showed that 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. The findings suggest 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.

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