Abstract 12019: Educational Attainment is Associated With Cardiac Rehabilitation Enrollment

Abstract

Introduction: Cardiac rehabilitation (CR) remains significantly underutilized. We examined the association of educational attainment (EA) with CR enrollment in a health claims database, hypothesizing that individuals with lower EA would be less likely to participate in CR. Methods: We employed an administrative database (Optum de-identified Clinformatics® Data Mart) to select individuals with incident events indicating CR eligibility from 2016-2018. We collected demographics (age, sex, race and ethnicity); comorbid conditions (hypertension, diabetes, stroke and those defined by the Elixhauser Comorbidity Index); household income; and CR qualifying event. In multivariable-adjusted logistic regression, we related EA (≤high school diploma; >high school diploma and <bachelor’s degree; ≥bachelor’s degree) to CR enrollment. We examined the association of EA and CR enrollment by race or ethnicity strata. Results: In 121,598 individuals eligible for CR, those with lower EA had lower odds of CR participation. Individuals with ≤high school diploma had 39% lower odds (95% Confidence Interval [CI] (35-42%) of enrolling in CR compared to those with ≥bachelor’s degree. The association of lower odds of CR enrollment with lower levels of EA persisted across racial and ethnic strata ( Figure ). Black individuals with ≥bachelor’s degree had similar odds of CR enrollment as White individuals with the same level of education (Odds Ratio [OR] 0.95, 95% CI 0.77-1.17). Hispanic (OR 0.26, 95% CI 0.23-0.28) and Asian individuals with ≤high school diploma (OR 0.25, 95% CI 0.19-0.33) had the lowest odds of CR enrollment compared with White individuals with ≥bachelor’s degree. Conclusions: We identified associations between EA and CR enrollment persisting across racial and ethnic strata. Our findings support increased attention to individuals with limited education to improve CR enrollment.