BACKGROUND: Although disparities in cardiac rehabilitation (CR) participation are well documented, the role of community-level distress is poorly understood. This study evaluated the relationship between community-level distress and CR participation, access to CR facilities, and clinical outcomes. METHODS: A retrospective cohort study was conducted on a 100% sample of Medicare beneficiaries undergoing inpatient coronary revascularization between July 2016 and December 2018. Community-level distress was defined using the Distressed Community Index quintile at the beneficiary zip code level, with the first and fifth quintiles representing prosperous and distressed communities, respectively. Outpatient claims were used to identify any CR use within 1 year of discharge. Beneficiary and CR facility zip codes were used to describe access to CR facilities. Adjusted logistic regression models evaluated the association between Distressed Community Index quintiles, CR use, and clinical outcomes, including one-year mortality, all-cause hospitalization, and acute myocardial infarction hospitalization. RESULTS: A total of 414 730 beneficiaries were identified, with 96 929 (23.4%) located in the first and 67 900 (16.4%) in the fifth quintiles, respectively. Any CR use was lower for beneficiaries in distressed compared with prosperous communities (26.0% versus 46.1%, P <0.001), which was significant after multivariable adjustment (odds ratio, 0.41 [95% CI, 0.40–0.42]). A total of 98 458 (23.7%) beneficiaries had a CR facility within their zip code, which increased from 16.3% in prosperous communities to 26.6% in distressed communities. Any CR use was associated with absolute reductions in mortality (−6.8% [95% CI, −7.0% to −6.7%]), all-cause hospitalization (−5.9% [95% CI, −6.3% to −5.6%]), and acute myocardial infarction hospitalization (−1.3% [95% CI, −1.5% to −1.1%]), which were similar across each Distressed Community Index quintiles. CONCLUSIONS: Although community-level distress was associated with lower CR participation, the clinical benefits were universally received. Addressing barriers to CR in distressed communities should be considered a significant priority to improve survival after coronary revascularization and reduce disparities.

中文翻译：

---

社区层面的痛苦与住院冠状动脉血运重建后心脏康复参与、设施使用和临床结果之间的关系

背景：尽管心脏康复（CR）参与方面的差异有据可查，但人们对社区层面的痛苦的作用却知之甚少。本研究评估了社区层面的痛苦与 CR 参与、CR 设施的使用和临床结果之间的关系。 方法：对 2016 年 7 月至 2018 年 12 月期间接受住院冠状动脉血运重建的医疗保险受益人的 100% 样本进行了一项回顾性队列研究。社区层面的痛苦是使用受益人邮政编码级别的痛苦社区指数五分位数来定义的，其中第一和第五五分位数是分别代表繁荣和贫困的社区。门诊索赔用于确定出院 1 年内是否使用 CR。受益人和 CR 设施邮政编码用于描述 CR 设施的使用情况。调整后的逻辑回归模型评估了痛苦社区指数五分位数、CR 使用和临床结果（包括一年死亡率、全因住院治疗和急性心肌梗死住院治疗）之间的关联。 结果：共确定了 414 730 名受益人，其中 96 929 人（23.4%）位于第一五分位，67 900 人（16.4%）位于第五五分位。与繁荣社区相比，贫困社区受益人的 CR 使用率较低（26.0% 比 46.1%，磷<0.001），多变量调整后显着（比值比，0.41 [95% CI，0.40-0.42]）。共有 98 458 名（23.7%）受益人在其邮政编码范围内拥有 CR 设施，这一比例从繁荣社区的 16.3% 增加到贫困社区的 26.6%。任何 CR 的使用都与死亡率（−6.8% [95% CI，−7.0% 至 −6.7%]）、全因住院率（−5.9% [95% CI，−6.3% 至 −5.6%]）的绝对降低相关。 ）和急性心肌梗死住院率（−1.3% [95% CI，−1.5% 至 −1.1%]），每个痛苦社区指数五分位数的情况相似。 结论：尽管社区层面的痛苦与 CR 参与率较低有关，但临床获益得到了普遍认可。应将解决贫困社区 CR 障碍视为提高冠状动脉血运重建后生存率并减少差异的重要优先事项。