Disparities in Geographic Access to Cardiac Rehabilitation in Los Angeles County
Background Exercise‐based cardiac rehabilitation (CR) is known to reduce morbidity and mortality for patients with cardiac conditions. Sociodemographic disparities in accessing CR persist and could be related to the distance between where patients live and where CR facilities are located. Our object...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-09-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.026472 |
| _version_ | 1797857413861212160 |
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| author | Joseph E. Ebinger Roy Lan Matthew P. Driver Parker Rushworth Eric Luong Nancy Sun Trevor‐Trung Nguyen Sarah Sternbach Amy Hoang Jacqueline Diaz Mallory Heath Brian L. Claggett C. Noel Bairey Merz Susan Cheng |
| author_facet | Joseph E. Ebinger Roy Lan Matthew P. Driver Parker Rushworth Eric Luong Nancy Sun Trevor‐Trung Nguyen Sarah Sternbach Amy Hoang Jacqueline Diaz Mallory Heath Brian L. Claggett C. Noel Bairey Merz Susan Cheng |
| author_sort | Joseph E. Ebinger |
| collection | DOAJ |
| description | Background Exercise‐based cardiac rehabilitation (CR) is known to reduce morbidity and mortality for patients with cardiac conditions. Sociodemographic disparities in accessing CR persist and could be related to the distance between where patients live and where CR facilities are located. Our objective is to determine the association between sociodemographic characteristics and geographic proximity to CR facilities. Methods and Results We identified actively operating CR facilities across Los Angeles County and used multivariable Poisson regression to examine the association between sociodemographic characteristics of residential proximity to the nearest CR facility. We also calculated the proportion of residents per area lacking geographic proximity to CR facilities across sociodemographic characteristics, from which we calculated prevalence ratios. We found that racial and ethnic minorities, compared with non‐Hispanic White individuals, more frequently live ≥5 miles from a CR facility. The greatest geographic disparity was seen for non‐Hispanic Black individuals, with a 2.73 (95% CI, 2.66–2.79) prevalence ratio of living at least 5 miles from a CR facility. Notably, the municipal region with the largest proportion of census tracts comprising mostly non‐White residents (those identifying as Hispanic or a race other than White), with median annual household income <$60 000, contained no CR facilities despite ranking among the county's highest in population density. Conclusions Racial, ethnic, and socioeconomic characteristics are significantly associated with lack of geographic proximity to a CR facility. Interventions targeting geographic as well as nongeographic factors may be needed to reduce disparities in access to exercise‐based CR programs. Such interventions could increase the potential of CR to benefit patients at high risk for developing adverse cardiovascular outcomes. |
| first_indexed | 2024-04-09T20:56:19Z |
| format | Article |
| id | doaj.art-51ffb3d92c0248318416736b46d692a5 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-09T20:56:19Z |
| publishDate | 2022-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-51ffb3d92c0248318416736b46d692a52023-03-29T18:38:57ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-09-01111810.1161/JAHA.121.026472Disparities in Geographic Access to Cardiac Rehabilitation in Los Angeles CountyJoseph E. Ebinger0Roy Lan1Matthew P. Driver2Parker Rushworth3Eric Luong4Nancy Sun5Trevor‐Trung Nguyen6Sarah Sternbach7Amy Hoang8Jacqueline Diaz9Mallory Heath10Brian L. Claggett11C. Noel Bairey Merz12Susan Cheng13Department of Cardiology Smidt Heart Institute, Cedars‐Sinai Medical Center Los Angeles CACollege of Medicine University of Tennessee Health Science Center Memphis TNDepartment of Cardiology Smidt Heart Institute, Cedars‐Sinai Medical Center Los Angeles CADepartment of Medicine Cedars‐Sinai Medical Center Los Angeles CADepartment of Cardiology Smidt Heart Institute, Cedars‐Sinai Medical Center Los Angeles CADepartment of Cardiology Smidt Heart Institute, Cedars‐Sinai Medical Center Los Angeles CADepartment of Cardiology Smidt Heart Institute, Cedars‐Sinai Medical Center Los Angeles CADepartment of Cardiology Smidt Heart Institute, Cedars‐Sinai Medical Center Los Angeles CADepartment of Cardiology Smidt Heart Institute, Cedars‐Sinai Medical Center Los Angeles CADepartment of Cardiology Smidt Heart Institute, Cedars‐Sinai Medical Center Los Angeles CADepartment of Cardiology Smidt Heart Institute, Cedars‐Sinai Medical Center Los Angeles CACardiovascular Division Brigham and Women’s Hospital Boston MADepartment of Cardiology Smidt Heart Institute, Cedars‐Sinai Medical Center Los Angeles CADepartment of Cardiology Smidt Heart Institute, Cedars‐Sinai Medical Center Los Angeles CABackground Exercise‐based cardiac rehabilitation (CR) is known to reduce morbidity and mortality for patients with cardiac conditions. Sociodemographic disparities in accessing CR persist and could be related to the distance between where patients live and where CR facilities are located. Our objective is to determine the association between sociodemographic characteristics and geographic proximity to CR facilities. Methods and Results We identified actively operating CR facilities across Los Angeles County and used multivariable Poisson regression to examine the association between sociodemographic characteristics of residential proximity to the nearest CR facility. We also calculated the proportion of residents per area lacking geographic proximity to CR facilities across sociodemographic characteristics, from which we calculated prevalence ratios. We found that racial and ethnic minorities, compared with non‐Hispanic White individuals, more frequently live ≥5 miles from a CR facility. The greatest geographic disparity was seen for non‐Hispanic Black individuals, with a 2.73 (95% CI, 2.66–2.79) prevalence ratio of living at least 5 miles from a CR facility. Notably, the municipal region with the largest proportion of census tracts comprising mostly non‐White residents (those identifying as Hispanic or a race other than White), with median annual household income <$60 000, contained no CR facilities despite ranking among the county's highest in population density. Conclusions Racial, ethnic, and socioeconomic characteristics are significantly associated with lack of geographic proximity to a CR facility. Interventions targeting geographic as well as nongeographic factors may be needed to reduce disparities in access to exercise‐based CR programs. Such interventions could increase the potential of CR to benefit patients at high risk for developing adverse cardiovascular outcomes.https://www.ahajournals.org/doi/10.1161/JAHA.121.026472Black individualscardiac rehabilitationcensus tractethnic and racial minoritiesLos Angelespopulation density |
| spellingShingle | Joseph E. Ebinger Roy Lan Matthew P. Driver Parker Rushworth Eric Luong Nancy Sun Trevor‐Trung Nguyen Sarah Sternbach Amy Hoang Jacqueline Diaz Mallory Heath Brian L. Claggett C. Noel Bairey Merz Susan Cheng Disparities in Geographic Access to Cardiac Rehabilitation in Los Angeles County Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease Black individuals cardiac rehabilitation census tract ethnic and racial minorities Los Angeles population density |
| title | Disparities in Geographic Access to Cardiac Rehabilitation in Los Angeles County |
| title_full | Disparities in Geographic Access to Cardiac Rehabilitation in Los Angeles County |
| title_fullStr | Disparities in Geographic Access to Cardiac Rehabilitation in Los Angeles County |
| title_full_unstemmed | Disparities in Geographic Access to Cardiac Rehabilitation in Los Angeles County |
| title_short | Disparities in Geographic Access to Cardiac Rehabilitation in Los Angeles County |
| title_sort | disparities in geographic access to cardiac rehabilitation in los angeles county |
| topic | Black individuals cardiac rehabilitation census tract ethnic and racial minorities Los Angeles population density |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.026472 |
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