ORIGINAL RESEARCH article
Front. Public Health
Sec. Life-Course Epidemiology and Social Inequalities in Health
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1562610
This article is part of the Research TopicPublic Health Outcomes: The Role of Social Security Systems in Improving Residents' Health WelfareView all 56 articles
Social Determinants of Health and Rehabilitation Service Areas: An Urban and Rural Mediation Analysis
Provisionally accepted
- 1The University of Texas Health Science Center at San Antonio, San Antonio, United States
- 2Sul Ross State University, Alpine, Texas, United States
- 3University of Texas Medical Branch at Galveston, Galveston, Texas, United States
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Introduction: Social determinants of health significantly shape community discharge rates in post-acute rehabilitation settings. Additionally, healthcare disparities between urban and rural regions in the United States can affect these discharge rates. These disparities underscore the critical need to understand how social, economic, educational, and healthcare-related factors influence community discharge outcomes to guide equitable healthcare strategies. Methods: This observational, cross-sectional study analyzed 40,476 ZIP Code Tabulation Area-level data points linked to Rehabilitation Service Areas and Agency for Healthcare Research and Quality datasets. Exploratory and confirmatory factor analyses identified five social determinants of health domains—social, economic, educational, physical infrastructure, and healthcare—which were assessed using structural equation modeling to evaluate their direct and mediated effects on community discharge rates. Results: Significant disparities in community discharge rates were observed across urban and rural areas. Urban areas exhibited lower community discharge rates, influenced by higher social and economic deprivation and limited English proficiency. Conversely, rural areas demonstrated higher rates, attributed to areal social, economic, and education characteristics. Key factors affecting community discharge outcomes included economic inequities, limited healthcare access, and transportation barriers. Conclusion: Targeted interventions addressing economic inequities, healthcare access, and transportation challenges are essential to improving community discharge outcomes. These findings inform policy and healthcare practices aimed at fostering equitable rehabilitation services and optimizing community reintegration.
Keywords: social determinants of health, Rehabilitation, Healthcare Disparities, Urban Health, Rural Health
Received: 31 Jan 2025; Accepted: 30 May 2025.
Copyright: © 2025 Nam, Schmidt, Dean, Bokov and Reistetter. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Timothy A Reistetter, The University of Texas Health Science Center at San Antonio, San Antonio, United States
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.