Abstract P21: Racial Disparity in Participation Among Patients in an Urban Cardiac Rehabilitation Program

Abstract

Background: Despite evidence of benefit on morbidity and mortality, cardiac rehabilitation (CR) remains underutilized. Studies have identified multiple reasons for lack of participation, but few have addressed racial disparities that may exist. Methods: A database of patients referred to CR between May 2001 and January 2011 was constructed. Data on gender, race, age, specialty of referring physician, co-payment, reason for referral, and attendance were collected. Racial groups were classified as Caucasian or minorities (African American, Hispanic, Asian, Pacific Islander, and multi-racial). Reasons for referral included acute MI, CAD, stable angina, CHF, and valvular heart disease. Data was analyzed using a Chi-square test to compare the initiation and non-initiation groups. A multivariate logistic regression estimated the odds ratio of variables predicting CR initiation. Results: Of the 822 patients referred to CR, 488 (59.4%) initiated CR and 334 (40.6%) did not. There was no difference in age (61.6 vs. 61.6, p = 0.987) or gender distribution (36.9% vs. 41.6% females, p = 0.161) between groups. Furthermore, need for co-payment (p = 0.091), reason for referral (p = 0.490), and whether the referring physician was a specialist or primary care physician (p = 0.740) did not affect attendance. Overall, minorities initiated CR less often than Caucasians (34.8% vs. 45.6%, p = 0.003). Based on the logistic regression analysis, Caucasians were 78% more likely to initiate CR (OR 1.78; 95% CI 1.13-2.80). Older age was a negative predictor of CR initiation, with each year of age decreasing likelihood of initiation by 2% (OR 0.98; 95% CI 0.96-1.00). Conclusions: Racial disparity exists amongst CR participants, with a clear under-representation of minorities in our urban medical center. Gender, physician referral patterns, and need for co-payment did not influence participation. Further investigation is required to determine why such disparity exists. Logistic regression analysis of factors predictive of CR initiation FACTORS ADJUSTED OR 95% CI P-VALUE Age 0.976 [0.956-0.995] 0.016 Gender 1.285 [0.836-1.977] 0.253 Caucasian Race 1.775 [1.126-2.797] 0.013 Co-payment 1.010 [0.987-1.033] 0.389 PCP/Specialist Referral 0.841 [0.495-1.428] 0.521