Association of Neighborhood Socioeconomic Context With Participation in Cardiac Rehabilitation
BackgroundCardiac rehabilitation (CR) is underutilized in the United States, with fewer than 20% of eligible patients participating in CR programs. Individual socioeconomic status is associated with CR utilization, but data regarding neighborhood characteristics and CR are sparse. We investigated th...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2017-10-01
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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.117.006260 |
| _version_ | 1818312268088082432 |
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| author | Justin M. Bachmann Shi Huang Deepak K. Gupta Loren Lipworth Michael T. Mumma William J. Blot Elvis A. Akwo Sunil Kripalani Mary A. Whooley Thomas J. Wang Matthew S. Freiberg |
| author_facet | Justin M. Bachmann Shi Huang Deepak K. Gupta Loren Lipworth Michael T. Mumma William J. Blot Elvis A. Akwo Sunil Kripalani Mary A. Whooley Thomas J. Wang Matthew S. Freiberg |
| author_sort | Justin M. Bachmann |
| collection | DOAJ |
| description | BackgroundCardiac rehabilitation (CR) is underutilized in the United States, with fewer than 20% of eligible patients participating in CR programs. Individual socioeconomic status is associated with CR utilization, but data regarding neighborhood characteristics and CR are sparse. We investigated the association of neighborhood socioeconomic context with CR participation in the SCCS (Southern Community Cohort Study). Methods and ResultsThe SCCS is a prospective cohort study of 84 569 adults in the southeastern United States from 2002 to 2009, 52 117 of whom have Medicare or Medicaid claims. Using these data, we identified participants with hospitalizations for myocardial infarction, percutaneous coronary intervention, or coronary artery bypass surgery and ascertained their CR utilization. Neighborhood socioeconomic context was assessed using a neighborhood deprivation index derived from 11 census‐tract level variables. We analyzed the association of CR utilization with neighborhood deprivation after adjusting for individual socioeconomic status. A total of 4096 SCCS participants (55% female, 57% black) with claims data were eligible for CR. CR utilization was low, with 340 subjects (8%) participating in CR programs. Study participants residing in the most deprived communities (highest quintile of neighborhood deprivation) were less than half as likely to initiate CR (odds ratio 0.42, 95% confidence interval, 0.27–0.66, P<0.001) as those in the lowest quintile. CR participation was inversely associated with all‐cause mortality (hazard ratio 0.77, 95% confidence interval, 0.60–0.996, P<0.05). ConclusionsLower neighborhood socioeconomic context was associated with decreased CR participation independent of individual socioeconomic status. These data invite research on interventions to increase CR access in deprived communities. |
| first_indexed | 2024-12-13T08:15:09Z |
| format | Article |
| id | doaj.art-8e1b0e8b95c04c67a41b2455efa8bb26 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T08:15:09Z |
| publishDate | 2017-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-8e1b0e8b95c04c67a41b2455efa8bb262022-12-21T23:54:07ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802017-10-0161010.1161/JAHA.117.006260Association of Neighborhood Socioeconomic Context With Participation in Cardiac RehabilitationJustin M. Bachmann0Shi Huang1Deepak K. Gupta2Loren Lipworth3Michael T. Mumma4William J. Blot5Elvis A. Akwo6Sunil Kripalani7Mary A. Whooley8Thomas J. Wang9Matthew S. Freiberg10Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TNVanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, TNDivision of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TNVanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, TNVanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TNDivision of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TNVanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, TNDivision of General Internal Medicine & Public Health, Vanderbilt University Medical Center, Nashville, TNMeasurement Science Quality Enhancement Research Initiative, Department of Veterans Affairs, University of California San Francisco, San Francisco, CADivision of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TNDivision of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TNBackgroundCardiac rehabilitation (CR) is underutilized in the United States, with fewer than 20% of eligible patients participating in CR programs. Individual socioeconomic status is associated with CR utilization, but data regarding neighborhood characteristics and CR are sparse. We investigated the association of neighborhood socioeconomic context with CR participation in the SCCS (Southern Community Cohort Study). Methods and ResultsThe SCCS is a prospective cohort study of 84 569 adults in the southeastern United States from 2002 to 2009, 52 117 of whom have Medicare or Medicaid claims. Using these data, we identified participants with hospitalizations for myocardial infarction, percutaneous coronary intervention, or coronary artery bypass surgery and ascertained their CR utilization. Neighborhood socioeconomic context was assessed using a neighborhood deprivation index derived from 11 census‐tract level variables. We analyzed the association of CR utilization with neighborhood deprivation after adjusting for individual socioeconomic status. A total of 4096 SCCS participants (55% female, 57% black) with claims data were eligible for CR. CR utilization was low, with 340 subjects (8%) participating in CR programs. Study participants residing in the most deprived communities (highest quintile of neighborhood deprivation) were less than half as likely to initiate CR (odds ratio 0.42, 95% confidence interval, 0.27–0.66, P<0.001) as those in the lowest quintile. CR participation was inversely associated with all‐cause mortality (hazard ratio 0.77, 95% confidence interval, 0.60–0.996, P<0.05). ConclusionsLower neighborhood socioeconomic context was associated with decreased CR participation independent of individual socioeconomic status. These data invite research on interventions to increase CR access in deprived communities.https://www.ahajournals.org/doi/10.1161/JAHA.117.006260cardiac rehabilitationneighborhood deprivationcardiovascular mortalitysocioeconomic position |
| spellingShingle | Justin M. Bachmann Shi Huang Deepak K. Gupta Loren Lipworth Michael T. Mumma William J. Blot Elvis A. Akwo Sunil Kripalani Mary A. Whooley Thomas J. Wang Matthew S. Freiberg Association of Neighborhood Socioeconomic Context With Participation in Cardiac Rehabilitation Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiac rehabilitation neighborhood deprivation cardiovascular mortality socioeconomic position |
| title | Association of Neighborhood Socioeconomic Context With Participation in Cardiac Rehabilitation |
| title_full | Association of Neighborhood Socioeconomic Context With Participation in Cardiac Rehabilitation |
| title_fullStr | Association of Neighborhood Socioeconomic Context With Participation in Cardiac Rehabilitation |
| title_full_unstemmed | Association of Neighborhood Socioeconomic Context With Participation in Cardiac Rehabilitation |
| title_short | Association of Neighborhood Socioeconomic Context With Participation in Cardiac Rehabilitation |
| title_sort | association of neighborhood socioeconomic context with participation in cardiac rehabilitation |
| topic | cardiac rehabilitation neighborhood deprivation cardiovascular mortality socioeconomic position |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.117.006260 |
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