Urban & Rural Area Mediation of the Relationship Between Social Determinants of Health & Community Discharge After Postacute Care Rehabilitation

PURPOSE: This study examines how urban and rural areas mediate the relationship between social determinants of health (SDH) and community discharge (CD) after rehabilitation. Occupational therapists play a key role in recovery. Understanding these area effects can improve interventions.

METHOD: We merged data from 1,711 Rehabilitation Service Areas and the Agency for Healthcare Research and Quality SDH Database focusing on five SDH domains: social, economic, education, physical infrastructure, and healthcare. Urban and Rural areas were defined using Rural Urban Commuting Area codes. Mediation analysis assessed the effects of these areas on the relationship between SDH and CD.

RESULTS: Urban and rural areas explained 3.45% of the partial mediating effect on the relationship between social factors and CD (total effect β=-.145), suggesting that higher rates of single-parent families, foreign-born individuals, and minority populations in urban areas decrease CD. Economic factors had mixed effects: higher poverty rates in urban areas reduced CD (β=-.130, 5.38%), while higher minority population poverty in rural areas increased CD (β=.228, 3.07%). Higher education in urban areas was tied to lower CD (β=-.276, 2.17%). Housing shortages in rural areas increased CD (β=.094, 11.70%), while greater public transportation in urban areas reduced CD (β=-.120, 3.33%). TRICARE/VA coverage in rural areas increased CD (β=.069, 11.59%).

CONCLUSION: Our findings of mediating effects for urban and rural areas suggest a complex relationship between SDH and CD. These findings can help occupational therapists tailor interventions to address both individual and area-level SDH factors to improve recovery and community participation.

IMPACT STATEMENT: Understanding how urban and rural differences mediate SDH and rehabilitation outcomes help therapists and policy makers understand and develop strategies to address social, environmental, and geographic factors that impact recovery.

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