Inequalities in therapeutic treatment during cardiac inpatient rehabilitation in Germany

Abstract

Cardiac patients of low socio-economic status (SES) display low health status and increased need for rehabilitation. This study's objective was to examine whether and to what extent inequalities in the provision of rehabilitative health care occur in Germany. We conducted an observational study with two points of measurement on 543 patients in cardiac inpatient rehabilitation. We used logistic regression and analysis of covariance to explore whether patients experience unequal therapeutic rehabilitative treatment. Patients of low SES were less frequently physically active, more likely to smoke and displayed a higher number of physical and psychological symptoms when entering rehabilitation. They were less likely to receive a number of therapies with differences being significant for core therapies of cardiovascular rehabilitation. Patients of higher SES received fewer hours of dietary counselling on average. While the latter difference might be in line with the needs of different socio-economic groups, most differences are unlikely to be tailored to patients' needs. Potential causes of inequalities in service provision like structural factors and aspects of the doctor-patient encounter should be further investigated.