Neighborhood Social Determinants of Health and Referral to Cardiac Rehabilitation: An Analysis of the Get With The Guidelines-Coronary Artery Disease Registry.

BACKGROUND

Despite strong guideline recommendations for cardiac rehabilitation (CR) following an acute myocardial infarction, CR referral is suboptimal, with disparities by sex, race, ethnicity, insurance, and geographic area. The influence of social determinants of health on CR referral has not been well studied.

METHODS

We analyzed cross-sectional data from the Get With The Guidelines-Coronary Artery Disease registry on patients discharged alive following an ST-segment-elevation myocardial infarction from 2020 to 2022. We used generalized estimating equations to analyze the association between neighborhood social determinants of health (using ZIP codes) and CR referral at discharge, controlling for patient- and hospital-level characteristics. We examined quintiles of the neighborhood Social Deprivation Index and the following social determinants of health domains: socioeconomic status (income, education, employment), culture (nativity and English proficiency), access to care, residential environment, and social support.

RESULTS

Among 79 694 patients hospitalized for acute myocardial infarction, the median age was 62 years, 28% were women, 72% were non-Hispanic White, and 82.6% were referred to CR at discharge. Patients residing in the most deprived Social Deprivation Index quintile had lower odds of being referred to CR than those in the least deprived quintile (adjusted odds ratio [aOR], 0.78 [95% CI, 0.64-0.96]). Patients had lower odds of being referred to CR if they resided in a neighborhood with high proportions of residents lacking a high school degree (aOR, 0.46 [95% CI, 0.31-0.68]), unemployed residents (aOR, 0.73 [95% CI, 0.58-0.91]), foreign-born residents (aOR, 0.63 [95% CI, 0.46-0.86]), residents with limited English proficiency (aOR, 0.51 [95% CI, 0.34-0.78]), and households without a vehicle (aOR, 0.74 [95% CI, 0.58-0.95]).

CONCLUSIONS

CR referral was lowest among patients living in the most deprived neighborhoods. Efforts are needed to equitably improve low CR referral rates among individuals living in the most deprived neighborhoods.