Abstract
Objective: To evaluate whether adherence and outcomes in cardiac rehabilitation are associated with socioeconomic status in a safety net hospital that provides care for a diverse patient population. Introduction: Uncovering the racial/ethnic health disparities that exist within cardiovascular medicine offers potential to mitigate treatment gaps that might affect outcomes. Since race is considered a social construct, socioeconomic status may be a more appropriate underlying factor to assess. The area deprivation index (ADI) reflects income, education, employment, and housing quality within a given 9-digit zip code. A higher ADI indicates more disadvantage (range 1-10). Methods: We identified 770 consecutive enrollees of the Cardiac Rehabilitation Program at Boston Medical Center from 2016-2020. The 9-digit zip codes of each enrollee were used to obtain their ADI. Associations between ADI and adherence (attending >70% of sessions) was evaluated while controlling for age, sex, race, education, diagnosis, smoking and transport times. Secondary outcomes included associations of ADI with change in exercise capacity, LDL cholesterol, weight, quality of life, nutrition, and depression scores. Results: Among 770 enrollees, 197 had missing covariates and 147 did not have a zip code with associated ADI, leaving 426 patients for analysis. Enrollees had a mean age of 59.8 years, 34% were female, 44% self-reported as black and 9% as Hispanic. The ADI for patients varied (mean =5; median =6) ( Figure 1 ). The primary outcome adjusted for age, sex, race, education, diagnosis, smoking, and transport time, revealed no association for ADI with adherence to cardiac rehab (OR, 1.03 95% CI:0.99-1.07) or attendance rate (OR, 0.98 95% CI: 0.96-1.004). Secondary outcomes improved among patients regardless of ADI. Conclusion: In our safety net hospital that provides care without exception, we found equity in cardiac rehabilitation program outcomes despite socioeconomic status.
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