Gaalema Diann E, Higgins Stephen T, Shepard Donald S, Suaya Jose A, Savage Patrick D, Ades Philip A
Departments of Psychiatry and Psychology (Drs Gaalema and Higgins) and Vermont Center on Behavior and Health (Drs Gaalema, Higgins, and Ades), University of Vermont, Burlington; Schneider Institutes for Health Policy, Brandeis University, Waltham, Massachusetts (Drs Shepard and Suaya); and Department of Medicine, Division of Cardiology, Fletcher Allen Health Care, Burlington, Vermont (Mr Savage and Dr Ades).
J Cardiopulm Rehabil Prev. 2014 Jul-Aug;34(4):248-54. doi: 10.1097/HCR.0000000000000059.
Wide geographic variations in cardiac rehabilitation (CR) participation in the United States have been demonstrated but are not well understood. Socioeconomic factors such as educational attainment are robust predictors of many health-related behaviors, including smoking, obesity, physical activity, substance abuse, and cardiovascular disease. We investigated potential associations between state-level differences in educational attainment, other socioeconomic factors, CR program availability, and variations in CR participation.
A retrospective database analysis was conducted using data from the US Census Bureau, the Centers for Disease Control and Prevention, and the 1997 Medicare database. The outcome of interest was CR participation rates by state, and predictors included state-level high school (HS) graduation rates (in 2001 and 1970), median household income, smoking rates, density of CR program (programs per square mile and per state population), sex and race ratios, and median age.
The relationship between HS graduation rates and CR participation by state was significant for both 2001 and 1970 (r = 0.64 and 0.44, respectively, P < .01). Adding the density of CR programs (per population) and income contributed significantly with a cumulative r value of 0.74 and 0.71 for the models using 2001 and 1970, respectively (Ps < .01). The amount of variance accounted for by each of the 3 variables differed between the 2000 and 1970 graduation rates, but both models were unaltered by including additional variables.
State-level HS graduation rates, CR programs expressed as programs per population, and median income were strongly associated with geographic variations in CR participation rates.
美国心脏康复（CR）参与率存在广泛的地域差异，这一点已得到证实，但人们对此了解并不充分。教育程度等社会经济因素是许多与健康相关行为的有力预测指标，包括吸烟、肥胖、体育活动、药物滥用和心血管疾病。我们调查了教育程度的州级差异、其他社会经济因素、CR项目可用性与CR参与率差异之间的潜在关联。
利用美国人口普查局、疾病控制与预防中心以及1997年医疗保险数据库的数据进行回顾性数据库分析。感兴趣的结果是各州的CR参与率，预测因素包括州级高中（HS）毕业率（2001年和1970年）、家庭收入中位数、吸烟率、CR项目密度（每平方英里和每州人口的项目数）、性别和种族比例以及年龄中位数。
2001年和1970年，州级HS毕业率与CR参与率之间的关系均具有显著性（r分别为0.64和0.44，P <.01）。对于分别使用2001年和1970年数据的模型，加入CR项目密度（按人口计算）和收入后，累积r值分别显著提高到0.74和0.71（P <.01）。2000年和1970年毕业率模型中，这三个变量各自解释的方差量有所不同，但加入其他变量后两个模型均未改变。
州级HS毕业率、以人均项目数表示的CR项目以及收入中位数与CR参与率的地域差异密切相关。
