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

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Study investigated the role of area economic characteristics in predicting employment using in adults with spinal cord injury (SCI). Geographically coded data were collected from two of the 14 SCI Model Systems centers and used to link individual-level data with area-level measures extracted from the 2000 United States Census. The analysis included 1,013 community-dwelling participants of working-age (18 to 64 years). Hierarchical generalized linear modeling was used to estimate area-level variation in participation and the relative contribution of area-level economic indicators, adjusted for individual-level health, functioning, and background characteristics. Results indicated that the likelihood of employment for adults with SCI varied by area and was associated with area socioeconomic status and urbanicity, but not area unemployment. These findings suggest that variation in area economic conditions may affect the feasibility of employment for people who experience chronic physical disability during adulthood, thus limiting full participation in society.

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