Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Drs Guhl, Zhu, Johnson, Mulukutla, and Magnani and Mr Thoma); Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (Drs Essien and Magnani); and Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania (Dr Essien).
J Cardiopulm Rehabil Prev. 2021 Sep 1;41(5):315-321. doi: 10.1097/HCR.0000000000000591.
Neighborhood socioeconomic status is associated with health outcomes. Cardiac rehabilitation (CR) provides a cost-effective, multidisciplinary approach to improve outcomes in cardiovascular disease. We aimed to evaluate the association of the Area Deprivation Index (ADI), a marker of neighborhood social composition, with risk of recurrent cardiovascular outcomes and assessed the modifying effect of CR.
We identified patients with a primary diagnosis of (1) myocardial infarction or (2) incident heart failure (HF) admitted to a large-sized regional health center during 2010-2018. We derived the ADI from home addresses and categorized it into quartiles (higher quartiles indicating increased deprivation). We obtained number of CR visits and covariates from the health record. We compared rehospitalization (cardiovascular, acute coronary syndrome [ACS], and HF) and mortality rates across ADI quartiles.
We included 6957 patients (age 69.2 ± 13.4 yr, 38% women, 89% White race). After covariate adjustment, the ADI was significantly associated with higher incidence rates (IRs)/100 person-yr of cardiovascular rehospitalization (quartile 1, IR 34.6 [95% CI, 31.2-38.2]; quartile 4, 41.5 [95% CI, 39.1-44.1], P < .001). In addition, the ADI was significantly associated with higher rates of rehospitalization for HF (P < .001), ACS (P < .012), and all-cause mortality (P < .04). These differences in rehospitalization and mortality rates by the ADI were no longer significant in those who attended CR.
We found the increased ADI was adversely associated with rehospitalizations and mortality. However, in individuals with CR, outcomes were significantly improved compared with those with no CR. Our findings suggest that CR participation has the potential to improve outcomes in disadvantaged neighborhoods.
社区社会经济地位与健康结果相关。心脏康复（CR）提供了一种具有成本效益的多学科方法，可改善心血管疾病的结果。我们旨在评估邻里剥夺指数（ADI）与心血管不良结局复发的相关性，ADI 是邻里社会构成的标志，并评估 CR 的调节作用。
我们从家庭住址中提取了 ADI，并将其分为四分位数（较高的四分位数表示贫困程度增加）。我们从健康记录中获得了 CR 就诊次数和协变量。我们比较了 ADI 四分位数之间的再住院（心血管、急性冠状动脉综合征[ACS]和心力衰竭[HF]）和死亡率。
我们纳入了 6957 名患者（年龄 69.2±13.4 岁，38%为女性，89%为白人）。经过协变量调整后，ADI 与较高的发生率（IR）/100 人年心血管再住院率显著相关（四分位 1，IR 34.6[95%CI，31.2-38.2]；四分位 4，41.5[95%CI，39.1-44.1]，P<.001）。此外，ADI 与 HF（P<.001）、ACS（P<.012）和全因死亡率（P<.04）的再住院率升高显著相关。在接受 CR 的患者中，ADI 对再住院和死亡率的影响不再显著。
我们发现 ADI 升高与再住院和死亡率呈负相关。然而，在接受 CR 的个体中，与未接受 CR 的个体相比，结局显著改善。我们的研究结果表明，CR 参与有可能改善弱势社区的结局。
