title: Do communities matter after rehabilitation? The effect of socioeconomic and urban stratification on well-being after spinal cord injury.
abstract: OBJECTIVE
  To assess the influence of community-level socioeconomic status (SES) and urban composition on well-being after spinal cord injury (SCI) rehabilitation.
  
  
  METHODS
  Retrospective analysis of cross-sectional survey data.
  
  
  METHODS
  Two participating centers in the SCI Model Systems (SCIMS) program.
  
  
  METHODS
  Persons (N=1454) with traumatic SCI from New Jersey and Alabama enrolled in the SCIMS database in 2000 to 2009.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Kessler Foundation Research Center, West Orange, NJ, USA. abotticello@kesslerfoundation.org
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Botticello
authors.forename: Yuying
authors.initials: Y
authors.lastname: Chen
authors.forename: Yue
authors.initials: Y
authors.lastname: Cao
authors.forename: David S
authors.initials: DS
authors.lastname: Tulsky
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000523:psychology* / Q000534:rehabilitation*; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult