Neighborhood Disadvantage and Risk of Hospitalization in a Home-Based Cardiac Rehabilitation Program After Acute Myocardial Infarction: A Retrospective Cohort Study.

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.