York University and University Health Network, Toronto, Canada.
Int J Equity Health. 2013 Aug 28;12:72. doi: 10.1186/1475-9276-12-72.
Despite greater need, rural inhabitants and individuals of low socioeconomic status (SES) are less likely to undertake cardiac rehabilitation (CR). This study examined barriers to enrollment and participation in CR among these under-represented groups.
Cardiac inpatients from 11 hospitals across Ontario were approached to participate in a larger study. Rurality was assessed by asking participants whether they lived within a 30-minute drive-time from the nearest hospital, with those >30 minutes considered "rural." Participants completed a sociodemographic survey, which included the MacArthur Scale of Subjective Social Status. One year later, they were mailed a survey which assessed CR utilization and included the Cardiac Rehabilitation Barriers Scale. In this cross-sectional study, CR utilization and barriers were compared by rurality and SES.
Of the 1809 (80.4%) retained, there were 215 (11.9%) rural participants, and the mean subjective SES was 6.37 ± 1.76. The mean CRBS score was 2.03 ± 0.73. Rural inhabitants reported attending significantly fewer CR sessions (p < .05), and greater CR barriers overall compared to urban inhabitants (p < .01). Patients of lower subjective SES were significantly less likely to be referred, enroll, and participate in CR, and reported significantly greater barriers to CR compared to their high SES counterparts (p < .01). Prominent barriers for both groups included distance, cost, and transportation problems. These relationships sustained adjustment, and a significant relationship between having undergone coronary artery bypass graft surgery and lower barriers was also identified.
The results confirm that rural inhabitants and patients of low SES experience greater barriers to CR utilization when compared to their urban, high SES counterparts. It is time to implement known strategies to overcome these barriers, to achieve equitable and greater use of CR.
尽管需求更大，但农村居民和社会经济地位（SES）较低的个体接受心脏康复（CR）的可能性较小。本研究旨在探讨这些代表性不足的群体在参与 CR 时所面临的障碍。
安大略省 11 家医院的心脏住院患者受邀参与一项更大的研究。通过询问参与者他们是否住在离最近医院 30 分钟车程内，来评估其居住的农村性。超过 30 分钟的被认为是“农村”。参与者完成了一项社会人口学调查，其中包括麦克阿瑟社会地位主观量表。一年后，他们收到了一份评估 CR 使用情况的问卷，其中包括心脏康复障碍量表。在这项横断面研究中，根据农村性和 SES 比较了 CR 的使用情况和障碍。
在保留的 1809 名参与者中，有 215 名（11.9%）来自农村，主观 SES 平均值为 6.37 ± 1.76。CRBS 平均得分为 2.03 ± 0.73。农村居民报告参加的 CR 课程明显较少（p <.05），并且与城市居民相比，整体上 CR 障碍更大（p <.01）。社会经济地位较低的患者被转诊、入组和参加 CR 的可能性明显较低，并且与高 SES 患者相比，报告的 CR 障碍明显更大（p <.01）。两个群体的主要障碍包括距离、费用和交通问题。这些关系在调整后仍然存在，并且还发现接受冠状动脉旁路移植手术与较低的障碍之间存在显著关系。
结果证实，与城市、高 SES 患者相比，农村居民和 SES 较低的患者在接受 CR 方面面临更大的障碍。现在是时候实施已知的策略来克服这些障碍，以实现 CR 的公平和更大使用。
