The impact of social determinants of health on stroke rehabilitation service utilization measured during acute stroke hospitalization

Rehabilitation is the primary method of promoting functional recovery post-stroke. Identification of patients for rehabilitation services during the acute stroke hospitalization is essential to delivery of rehabilitation services. Social determinants of health (SDOH) impact health care and health outcomes in a myriad of ways, but it is unknown whether SDOH affects rehabilitation services utilization.
This study elucidates the relationship of, and additional explanatory value of, county-level metrics of SDOH on rehabilitation services utilization during acute inpatient hospitalization for stroke.
Using the American Heart Association Get with the Guidelines®-Stroke registry and the Institute for Health Metrics and Evaluation data, we investigated the impact of SDOH on rehabilitation services utilization over the years ranging from 2010 to 2019 in hospitalized ischemic stroke or intracerebral hemorrhage stroke patients. Analyses focused on determining which county-level SDOH metrics influenced rehabilitation services utilization using generalized linear mixed models. Akaike Information Criterion was used for model selection.
County-level SDOH improved the predictive ability of the models to determine who would be transferred to a rehabilitation facility and who would be referred for rehabilitation after discharge. We found indicators that county-level metrics of high school education (p = 0.0003), being foreign-born (p < 0.001), and rurality of the hospital (p = 0.004) influenced rehabilitation services utilization.
SDOH impact rehabilitation utilization after acute stroke hospitalization. Future studies should focus on both individual- and county-level metrics of SDOH and their impact on access to rehabilitation. This information should be used to develop interventions to improve the equity of rehabilitation utilization after stroke.