title: Sex differences in cardiac rehabilitation enrollment: a meta-analysis.
abstract: BACKGROUND
  The present systematic review and meta-analysis examines studies published in the past 10 years that described cardiac rehabilitation (CR) enrollment among women and men, to determine whether a significant sex difference persists despite the evidence supporting the benefits of CR to women as well as men.
  
  
  METHODS
  Scopus, MEDLINE, CINAHL, PsycINFO, PubMed, and The Cochrane Library databases were systematically searched for peer-reviewed articles published from July 2000 to July 2011. Titles and abstracts were screened, and the 623 selected full-text articles were independently screened based on predefined inclusion/exclusion criteria (guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PRISMA) and assessed for quality using the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement form. The meta-analysis was undertaken using Review Manager software.
  
  
  RESULTS
  Twenty-six eligible observational studies reporting data for 297,719 participants (128,499 [43.2%] women) were included. On average, 45.0% of men and 38.5% of women enrolled in CR. In the pooled analysis, men were more likely to be enrolled in CR compared with women (female enrollment vs male enrollment odds ratio, 0.64; 95% confidence interval, 0.57-0.72; P < 0.00001). Heterogeneity was considered high (I(2) = 78%). In the subgroup analyses, systematic CR referral during inpatient tertiary care resulted in significantly greater enrollment among women than nonsystematic referral.
  
  
  CONCLUSIONS
  Overall, rates of CR enrollment among women are significantly lower compared with men, with women being 36% less likely to enroll in a rehabilitation program.
authors.affiliation: Department of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
authors.forename: Liz
authors.initials: L
authors.lastname: Samayoa
authors.affiliation: Department of Kinesiology and Health Science, York University, Toronto, Ontario, Canada; Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada. Electronic address: sgrace@yorku.ca.
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
authors.affiliation: School of Health Technology and Management and Department of Medicine, School of Medicine, Stony Brook Medicine, Stony Brook, New York, USA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Gravely
authors.affiliation: School of Health Technology and Management and Department of Medicine, School of Medicine, Stony Brook Medicine, Stony Brook, New York, USA.
authors.forename: Lisa Benz
authors.initials: LB
authors.lastname: Scott
authors.affiliation: Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Marzolini
authors.affiliation: Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada.
authors.forename: Tracey J F
authors.initials: TJ
authors.lastname: Colella
mesh_terms: D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D005081:Exercise Therapy; D014943:Global Health; D006801:Humans; D009017:Morbidity / Q000639:trends; D010353:Patient Education as Topic; D012017:Referral and Consultation; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D017678:Sex Distribution; D012737:Sex Factors