Contextualizing Employment Outcomes After Spinal Cord Injury With Novel Area-Level Economic Measures: A Cross-Sectional Analysis of the National Spinal Cord Injury Model Systems Database.

Abstract

To investigate the association of area-level economic characteristics with employment outcomes in a sample of participants in the national Spinal Cord Injury Model Systems (SCIMS) database. Secondary analysis of cross-sectional survey data collected for the SCIMS database linked to administrative data from the 2019 American Community Survey (ACS) 5-year estimates. Community. Not applicable. People with traumatic spinal cord injury (SCI) who completed a follow-up interview during the 2016-2021 SCIMS database cycle and who had census tract-level geographic identifiers to link to the 2019 ACS data (N=4660). Employment status was a binary measure indicating participants' status as employed (=1) or not employed (=0) at the time of follow-up interview. A total of 40% of participants reported being employed at the time of interview. Compared with those living in low socioeconomic status (SES) neighborhoods, those living in moderate-SES neighborhoods had 50% greater odds of being employed and those living in high-SES neighborhoods had more than double the odds of employment. The probability of employment also varied by urbanicity. Among all people living in low-SES neighborhoods, the probability of employment was lower for people in rural (27%) versus urban (38%) areas, whereas people living in high-SES rural and urban areas had a similar probability of being employed. Area-level economic characteristics have a significant effect on the odds of employment after SCI over and above individual-level characteristics. People living in low-SES neighborhoods had poorer odds of employment, especially those in low-SES rural areas. These findings inform rehabilitation professionals' consideration of community characteristics in employment initiatives for people living with SCI.