Journal of the American Heart Association · 2025
Neighborhood Disadvantage and Risk of Hospitalization in a Home-Based Cardiac Rehabilitation Program After Acute Myocardial Infarction: A Retrospective Cohort Study.
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Thapa Barune, Reynolds Kristi, Duggan Mark, Mefford Matthew T, Nkonde-Price Chileshe
Аннотация
BACKGROUND: Cardiovascular disease outcomes are worse among individuals living in socioeconomically disadvantaged neighborhoods. Whether home-based cardiac rehabilitation can mitigate this risk following acute myocardial infarction is unknown.
METHODS: We conducted a retrospective cohort study of 420 adults hospitalized for acute myocardial infarction between April 2018 and April 2019 who subsequently enrolled in an 8-week home-based cardiac rehabilitation program within an integrated health care system. Neighborhood disadvantage was measured using a standardized Neighborhood Deprivation Index assigned at the census tract level and categorized into quartiles (quartile 1, least disadvantaged; quartile 4, most disadvantaged). The primary outcome was all-cause inpatient hospitalization at 30 days, 90 days, and 12 months after home-based cardiac rehabilitation initiation. Logistic regression models estimated odds of hospitalization by Neighborhood Deprivation Index quartile, adjusted for age, sex, comorbidities, and race and ethnicity.
RESULTS: The mean age was 62 years; 27.4% were women; and 45.5% were White, 30.5% Hispanic, 12.6% Asian, and 7.6% Black individuals. Overall, 48.1% of patients experienced ≥1 hospitalization within 12 months. Hospitalization rates increased with neighborhood disadvantage (eg, 12 months: 41.6% in quartile 1 versus 52.2% in quartile 4). In fully adjusted models, patients in quartile 4 had significantly higher odds of 30-day (odds ratio, 2.04 [95% CI, 1.08-3.98]) and 12-month hospitalization (odds ratio, 2.03 [95% CI, 1.08-3.81]) compared with quartile 1. Race and ethnicity were not consistently associated with hospitalization, though Black patients had lower odds at 12 months.
CONCLUSIONS: Neighborhood socioeconomic disadvantage was associated with significantly higher hospitalization risk among patients in home-based cardiac rehabilitation after acute myocardial infarction. Additional interventions targeting structural inequities are needed to improve outcomes among marginalized populations.
METHODS: We conducted a retrospective cohort study of 420 adults hospitalized for acute myocardial infarction between April 2018 and April 2019 who subsequently enrolled in an 8-week home-based cardiac rehabilitation program within an integrated health care system. Neighborhood disadvantage was measured using a standardized Neighborhood Deprivation Index assigned at the census tract level and categorized into quartiles (quartile 1, least disadvantaged; quartile 4, most disadvantaged). The primary outcome was all-cause inpatient hospitalization at 30 days, 90 days, and 12 months after home-based cardiac rehabilitation initiation. Logistic regression models estimated odds of hospitalization by Neighborhood Deprivation Index quartile, adjusted for age, sex, comorbidities, and race and ethnicity.
RESULTS: The mean age was 62 years; 27.4% were women; and 45.5% were White, 30.5% Hispanic, 12.6% Asian, and 7.6% Black individuals. Overall, 48.1% of patients experienced ≥1 hospitalization within 12 months. Hospitalization rates increased with neighborhood disadvantage (eg, 12 months: 41.6% in quartile 1 versus 52.2% in quartile 4). In fully adjusted models, patients in quartile 4 had significantly higher odds of 30-day (odds ratio, 2.04 [95% CI, 1.08-3.98]) and 12-month hospitalization (odds ratio, 2.03 [95% CI, 1.08-3.81]) compared with quartile 1. Race and ethnicity were not consistently associated with hospitalization, though Black patients had lower odds at 12 months.
CONCLUSIONS: Neighborhood socioeconomic disadvantage was associated with significantly higher hospitalization risk among patients in home-based cardiac rehabilitation after acute myocardial infarction. Additional interventions targeting structural inequities are needed to improve outcomes among marginalized populations.