title: Racial disparities in cardiac rehabilitation initiation and the effect on survival.
abstract: OBJECTIVE
  To examine predictors of initiation and adherence, identify racial disparities, and compare the survival benefit of cardiac rehabilitation between a white and a unique predominantly non-white minority in an urban environment.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  The outpatient cardiac rehabilitation program at Montefiore Medical Center, Bronx, New York.
  
  
  METHODS
  Consecutive patients (n = 822) referred to outpatient cardiac rehabilitation were evaluated.
  
  
  METHODS
  Baseline characteristics and outcomes were ascertained from medical records. Multivariate logistic regression was used to examine the association among initiation, age, gender, race, reason for referral, and copayment. Kaplan-Meier analysis was performed to evaluate mortality outcomes.
  
  
  METHODS
  Racial disparities in rates of initiation, adherence and completion, and survival benefit associated with cardiac rehabilitation.
  
  
  RESULTS
  Among 822 patients referred (51.5% non-white minorities, 61.1% male), 59.4% initiated cardiac rehabilitation. Non-white minorities initiated cardiac rehabilitation less often than did white patients (54.4% versus 65.2%, P = .003). After adjustment, white patients were 77.5% more likely to initiate cardiac rehabilitation (odds ratio 1.78; 95% confidence interval 1.13-2.80). Both white populations and non-white minorities who participated in cardiac rehabilitation had a lower risk of death (P = .0022).
  
  
  CONCLUSIONS
  In a predominantly minority population, racial disparities exist among cardiac rehabilitation participants. Minorities were less likely to initiate cardiac rehabilitation. Gender, referral patterns, and the presence of copayment did not influence initiation. Cardiac rehabilitation initiation was associated with decreased mortality.
authors: The Arthur S. Abramson Department of Rehabilitation Medicine, Einstein Division/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY(∗).
authors: David Z
authors: DZ
authors: Prince
authors: Division of Cardiology, Department of Medicine, Einstein Division/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY(†).
authors: Maria
authors: M
authors: Sobolev
authors: Division of Cardiology, Department of Medicine, Einstein Division/Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY(‡).
authors: Ju
authors: J
authors: Gao
authors: Division of Cardiology, Department of Medicine, Einstein Division/Montefiore Medical Center, Albert Einstein College of Medicine, 1825 Eastchester Road, Room WT120, Bronx, NY 10461(§). Electronic address: ctaub@montefiore.org.
authors: Cynthia C
authors: CC
authors: Taub
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care / Q000592:standards / Q000639:trends; D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality*; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009519:New York City; D016017:Odds Ratio; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D014505:Urban Population; D044465:White People / Q000706:statistics & numerical data