Rural-urban disparities in healthcare factors and long-term health outcomes in individuals with pediatric-onset spinal cord injury

Kyle C Deane; Nikhil Kurapati; Emma Gill; Lawrence C Vogel; Kathy Zebracki

doi:10.3389/fresc.2023.1102441

Rural-urban disparities in healthcare factors and long-term health outcomes in individuals with pediatric-onset spinal cord injury

Front Rehabil Sci. 2023 May 19:4:1102441. doi: 10.3389/fresc.2023.1102441. eCollection 2023.

Authors

Kyle C Deane^{1

2}, Nikhil Kurapati³, Emma Gill⁴, Lawrence C Vogel^{1

5}, Kathy Zebracki^{1

2

6}

Affiliations

¹ Department of Psychology, Shriners Children's Chicago, Chicago, IL, United States.
² Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States.
³ Department of Family Medicine, Soin Medical Center, Beavercreek, OH, United States.
⁴ Department of Psychiatry, Northwell Health, Queens, NY, United States.
⁵ Department of Pediatrics, Rush Medical College, Chicago, IL, United States.
⁶ Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.

Abstract

Objective: Adults with pediatric-onset spinal cord injury (SCI) require long-term care and demonstrate elevated risk of secondary health conditions and psychosocial challenges. Medical providers are typically found in more populous and wealthy areas, resulting in a relative lack of providers in rural areas, a discrepancy even more pronounced among specialty providers. As a result, those who reside in rural regions potentially have unmet medical needs, representing a significant public health concern. The purpose of this study was to assess differences between rural and urban-residing participants with pediatric-onset SCI in factors affecting healthcare usage (e.g., employment, income, access to private insurance, community integration) and long-term healthcare outcomes (i.e., secondary health conditions and psychosocial functioning).

Methods: Data were gathered from an ongoing study examining long-term outcomes of adults with pediatric-onset SCI. Participants (N = 490) completed measures of sociodemographics, injury characteristics, and medical outcomes. Participant zip codes were classified as rural or urban using the ProximityOne database based on the ZIP Code Tabulation Areas from the 2020 census.

Results: Individuals residing in rural regions report lower levels of education, income, employment rates, private health insurance, and community integration (mobility, occupation, and social engagement), as well increased incidence of pressure injuries, urinary tract infections, hospitalizations, bowel incontinence, sleep difficulties, and perceived physical health. No differences in incidence of psychosocial functioning were identified.

Conclusion: Mitigating identified disparities and obstacles to treatment of SCI due to residing in rural environments would result in important improvements in treatment outcomes and future prevention efforts of secondary health complications, improving the overall health of adults with pediatric-onset SCI.

Keywords: health care access; health disparities; long-term outcomes; pediatric; rural; spinal cord injury; urban.

Grants and funding

This research was supported by Shriners Children's.