Disparities in Geographic Access to Cardiac Rehabilitation in Los Angeles County

Abstract

Background Exercise‐based cardiac rehabilitation (CR) is known to reduce morbidity and mortality for patients with cardiac conditions. Sociodemographic disparities in accessing CR persist and could be related to the distance between where patients live and where CR facilities are located. Our objective is to determine the association between sociodemographic characteristics and geographic proximity to CR facilities. Methods and Results We identified actively operating CR facilities across Los Angeles County and used multivariable Poisson regression to examine the association between sociodemographic characteristics of residential proximity to the nearest CR facility. We also calculated the proportion of residents per area lacking geographic proximity to CR facilities across sociodemographic characteristics, from which we calculated prevalence ratios. We found that racial and ethnic minorities, compared with non‐Hispanic White individuals, more frequently live ≥5 miles from a CR facility. The greatest geographic disparity was seen for non‐Hispanic Black individuals, with a 2.73 (95% CI, 2.66–2.79) prevalence ratio of living at least 5 miles from a CR facility. Notably, the municipal region with the largest proportion of census tracts comprising mostly non‐White residents (those identifying as Hispanic or a race other than White), with median annual household income <$60 000, contained no CR facilities despite ranking among the county's highest in population density. Conclusions Racial, ethnic, and socioeconomic characteristics are significantly associated with lack of geographic proximity to a CR facility. Interventions targeting geographic as well as nongeographic factors may be needed to reduce disparities in access to exercise‐based CR programs. Such interventions could increase the potential of CR to benefit patients at high risk for developing adverse cardiovascular outcomes.

Patient Preferences for Cardiac Rehabilitation – A Systematic Review

“…The lack of data in some regions and the variability of healthcare systems between the areas limit the generalizability of the results. 61 , 62 …”

Relationship Between Community-Level Distress and Cardiac Rehabilitation Participation, Facility Access, and Clinical Outcomes After Inpatient Coronary Revascularization

“…These findings are in line with a study of Los Angeles residents showing that racial/ethnic minority groups were more likely to have CR facilities 5 or more miles away relative to their white counterparts. 15 However, it is unclear if the increased distance is associated with decreased utilization, as prior studies have shown that distances over 30 miles are linked to lower rates of use. 25 Interventions focused on improving CR access may, therefore, need to be tailored based on whether CR facilities are in close proximity to patients.…”

“…[12][13][14] Patients in lowerincome neighborhoods may also have lower rates of CR participation because of limited access to CR facilities. 15 Over and above the established predictors of participation in CR, none of the above studies have evaluated the independent relationship between community-level distress and CR participation at a national level. Moreover, there is limited evidence of an association between CR participation and outcomes across levels of community distress.…”

Racial & ethnic disparities in geographic access to critical care in the United States: A geographic information systems analysis

“…Prior studies have shown disparities in access to key resources such as COVID-19 vaccination sites, pediatric trauma centers, dialysis units and cardiac rehabilitation centers [13,[40][41][42]. It is clear from this data that critical care resources are also not equitably available to all areas and populations of the US.…”