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Impact of Social Factors on Racial Differences in Cardiac Rehabilitation Participation

Guhl, Emily (2021) Impact of Social Factors on Racial Differences in Cardiac Rehabilitation Participation. Master's Thesis, University of Pittsburgh. (Unpublished)

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Background: Cardiac rehabilitation (CR) is a multidisciplinary program that employs structured exercise training for secondary prevention of cardiovascular disease. CR has been shown to improve mortality, rehospitalizations, patient-centered outcomes, and recurrent cardiovascular events. CR participation rates are suboptimal with disparities among nonwhite minorities. We sought to determine the participation rate among CR-eligible patients stratified by race and to evaluate the social factors associated with racial differences in participation.
Methods: Using administrative claims data, we identified adults with CR-eligible diagnoses between 2016-2018. Sociodemographic and clinical factors including age, race, sex, Elixhauser Comorbidity Index, hypertension, diabetes, ischemic stroke, household income, household net worth, education level, and qualifying diagnosis type were obtained for each individual. We determined rate of CR participation using billing codes and stratified by race. Odds of enrolling in CR by clinical and sociodemographic characteristics was obtained using multivariate logistic regression including models with interaction terms for social factors (educational level, household income) and race.
Results: Our final analytic sample included 124,963 individuals who were 70 years old, 62.3% male, 75.1% white race, 11.7% with a Bachelor’s Degree or higher, 31.5% with a household income <40K, 92.6% with hypertension, and 50.4% with diabetes. Of those CR-eligible, 25.8% had any participation in CR. Compared to White individuals, Black, Hispanic, and Asian individuals were 25%, 52%, and 45% less likely to have CR participation, (p<0.0001). Individual with female sex, non-procedural qualifying diagnosis, lower education level, lower income, and comorbidities were also significantly less likely to participate in CR. We found significant interaction between race and education (p=0.0059) and race and household income (p=0.0158) on CR-participation.
Public Health Significance: While it is established race is a predictor of CR participation, our study adds to the body of evidence by identifying social factors, such as income and education, as both independent predictors and mediators of participation. Knowledge of social factors that impact CR participation and incorporating these factors into health care delivery systems provides an opportunity to address disparities and improve outcomes in vulnerable populations.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Guhl, Emilyemg123@pitt.eduemg1230000-0002-9153-6016
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Thesis AdvisorMagnani, Jaredmagnanij@pitt.edumagnanji
Committee MemberBarinas-Mitchell, Emmabarinas@edc.pitt.edubarinas
Committee ChairSekikawa, Akiraakira@pitt.eduakira
Date: 12 May 2021
Date Type: Publication
Defense Date: 9 April 2021
Approval Date: 12 May 2021
Submission Date: 12 April 2021
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 58
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: MS - Master of Science
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: Cardiac rehabilitation, race, social determinants of health
Date Deposited: 13 May 2021 02:26
Last Modified: 12 May 2023 05:15

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