Key result
High neighborhood social deprivation linked to ~22% lower cardiac rehabilitation referral after post-MI discharge.
Why the study?
Cardiac rehabilitation referral post-myocardial infarction is suboptimal with known demographic disparities, but the influence of social determinants of health on referral has not been well studied.
Does living in a socially deprived neighborhood reduce referral to cardiac rehabilitation in patients discharged after STEMI?
Cross-Sectional (n=79,694)
Yes
Does living in a socially deprived neighborhood reduce referral to cardiac rehabilitation in patients discharged after STEMI?
Odds Ratio: 0.78 (95% CI 0.64–0.96)
Absolute Event Rate: 79.1% vs 84%
Living in socially deprived neighborhoods is associated with significantly lower odds of cardiac rehabilitation referral at discharge following an acute myocardial infarction, highlighting the need for targeted efforts to improve equitable access.
May highlight post-MI referral inequities; hypothesis-generating for equity interventions before practice change.
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 female, 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 with postmyocardial infarction living in the most deprived neighborhoods. Efforts are needed to equitably improve low CR referral rates among individuals living in the most deprived neighborhoods.
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McLaughlin et al. (2026) conducted a cross-sectional in Acute myocardial infarction (n=79,694). Neighborhood social deprivation (most deprived Social Deprivation Index quintile) vs. Least deprived Social Deprivation Index quintile was evaluated on Referral to cardiac rehabilitation at discharge (aOR 0.78, 95% CI 0.64-0.96). Patients hospitalized for acute myocardial infarction residing in the most socially deprived neighborhoods had 22% lower odds of being referred to cardiac rehabilitation at discharge (aOR 0.78).
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