Influence of social determinants of health on post-acute use and outcome: a scoping review.

Introduction: Social determinants of health (SDoH) account for more than half of the variation in health outcomes. However, their role in post-acute care for neurologic conditions remains poorly understood. Clarifying how SDoH influences post-acute utilization and outcomes is critical for improving equity and informing rehabilitation policy. Methods: We conducted a scoping review of U.S.-based studies published between 2005 and 2025 examining associations between SDoH and length of stay, functional improvement, community discharge, and 30-day readmission in inpatient rehabilitation facilities and skilled nursing facilities among adults with stroke and traumatic brain injury. Results: Among 32 studies, social and community context was the most frequently examined SDoH domain, and functional improvement was the commonly studied outcome. Insurance type, race and ethnicity, and marital status were consistently associated with all outcomes. Medicaid and dual-eligible beneficiaries had shorter hospital stays and smaller functional gains compared with those with commercial insurance. Caregivers support increased community discharge. Lower education and Black or Hispanic race/ethnicity increased readmission risk. Despite consistent associations, SDoH were inconsistently measured. Conclusion: Integrating SDoH into post-acute care assessment may improve equity in discharge planning and recovery.