Disparities in women's referral to and enrollment in outpatient cardiac rehabilitation.
OBJECTIVE
The purpose of this study was to determine the predictors of referral and enrollment, including racial differences, in phase 2 cardiac rehabilitation programs among African-American and white women who are eligible for such programs.


METHODS
Prospective longitudinal design.


METHODS
One large academic medical center and two large community hospitals.


METHODS
A total of 253 women (108 African American, 145 white) were surveyed within the first month of discharge from the hospital for a percutaneous coronary intervention, coronary artery bypass surgery, or myocardial infarction without revascularization. A total of 234 (99 African American, 135 white) completed the 6-month follow-up.


RESULTS
The rate of referral to outpatient phase 2 cardiac rehabilitation was significantly lower for African-American women compared with white women, 12 (12%) versus 33 (24%) (P=.03). Only 35 (15%) of women in the study reported enrollment in phase 2 cardiac rehabilitation programs, with fewer African-American women reporting enrollment compared with white women, 9 (9%) versus 26 (19%) (P=.03). Controlling for age, education, angina class, and comorbidities, women with annual incomes <20,000 dollars were 66% less likely to be referred to cardiac rehabilitation (P=.01) and 60% less likely to enroll compared to women with incomes >20,000 dollars (P=.01). Although borderline significant, African-American women were 55% less likely to be referred (P=.059) and 58% less likely to enroll (P=.059) than white women.


CONCLUSIONS
We found disparities in cardiac rehabilitation program participation, with women with lower incomes less likely to be referred and to have lower enrollment rates in cardiac rehabilitation and a strong trend for African-American women to be less likely to be referred and enroll. Because almost all patients who have had an acute coronary event, with or without revascularization procedures, will benefit from cardiac rehabilitation, automatic referral systems should be considered to increase utilization and reduce disparities.
Allen
Jerilyn K
JK
Johns Hopkins University School of Nursing, Baltimore, MD 21205, USA. jallen@son.jhmi.edu
Scott
Lisa Benz
LB
Stewart
Kerry J
KJ
Young
Deborah Rohm
DR
D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D003327:Coronary Disease / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008137:Longitudinal Studies; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data