Factors Associated with Employment, Household Income and Income Satisfaction Following Spinal Cord Injury in South Africa

Paid employment, household income and income satisfaction are distinct post-SCI socioeconomic outcomes that may reflect not only injury severity but also broader social and system-level influences. This study examined factors associated with these three outcomes among adults living with SCI in South Africa. This cross-sectional secondary analysis used data collected during the South African implementation of the second International Spinal Cord Injury (InSCI) Community Survey, which constituted a new round of data collection. Community-dwelling adults aged 18 years or older and at least 12 months post-injury were recruited from four provinces using a pragmatic convenience-sampling approach; 461 participants were included. Hierarchical regression models assessed injury-related, sociodemographic and system/environmental factors, interpreted through a social-determinants-of-health lens. Injury-related factors explained little variance overall, whereas education was consistently associated with all three outcomes. In the final employment model, each additional system/environmental barrier was associated with lower odds of paid employment (OR 0.77, 95% CI 0.66–0.89). The barrier score was not associated with household income but was associated with lower odds of income satisfaction (OR 0.83, 95% CI 0.72–0.95). These cross-sectional findings indicate that post-SCI employment and financial outcomes were associated with factors beyond lesion characteristics alone; they do not establish causal relationships. Sensitivity analysis using the original 1–10 income-satisfaction scale retained the strong education pattern, whereas the barrier-count association was attenuated and did not reach conventional statistical significance (p = 0.076). The cumulative system/environmental barrier count was exploratory and was not a validated psychometric scale. Because recruitment was service-linked and restricted to four purposively selected provinces, the findings should not be interpreted as nationally representative.