Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, TN.
J Am Heart Assoc. 2017 Oct 11;6(10):e006260. doi: 10.1161/JAHA.117.006260.
Cardiac 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).
The 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, <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, <0.05).
Lower 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.
在美国，心脏康复（CR）的利用率较低，只有不到 20%的符合条件的患者参加 CR 项目。个体社会经济地位与 CR 的利用有关，但关于社区特征与 CR 的数据很少。我们调查了社区社会经济环境与 SCCS（南方社区队列研究）中 CR 参与的关系。
SCCS 是一项在美国东南部进行的前瞻性队列研究，纳入了 2002 年至 2009 年间的 84569 名成年人，其中 52117 人有医疗保险或医疗补助索赔。利用这些数据，我们确定了因心肌梗死、经皮冠状动脉介入治疗或冠状动脉旁路移植术住院的患者，并确定了他们接受 CR 的情况。使用来自 11 个普查区水平变量的社区剥夺指数评估社区社会经济环境。在调整个体社会经济地位后，我们分析了 CR 利用率与社区剥夺之间的关系。共有 4096 名 SCCS 参与者（55%为女性，57%为黑人）有索赔数据，符合 CR 条件。CR 的利用率较低，只有 340 名（8%）参与者参加了 CR 项目。居住在最贫困社区（社区剥夺程度最高的五分位数）的研究参与者开始 CR 的可能性不到最低五分位数的一半（比值比 0.42，95%置信区间 0.27-0.66，<0.001）。CR 参与与全因死亡率呈负相关（风险比 0.77，95%置信区间 0.60-0.996，<0.05）。
较低的社区社会经济环境与独立于个体社会经济地位的 CR 参与减少有关。这些数据引发了关于在贫困社区增加 CR 机会的干预措施的研究。
