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The newspaper of The Johns Hopkins University August 2, 2004 | Vol. 33 No. 41
Income, Race May Predict Women's Cardiac Rehab Referral

By Lynn Writzel
School of Nursing

Disparities in the rates of referral and subsequent enrollment in outpatient cardiac rehabilitation can be linked to income and race, according to a study published in the July issue of The Journal of General Internal Medicine. The study, led by Jerilyn K. Allen, associate dean for research at the Johns Hopkins School of Nursing, showed lower outpatient cardiac rehabilitation referral and enrollment rates — post acute coronary events — for low-income and African-American women.

A total of 253 women, 108 African-American and 145 white, were surveyed within one month of discharge from three major hospitals serving Baltimore City and its surrounding counties. Only 44 (19 percent) self-reported receiving a health care professional's referral to cardiac rehabilitation. Low-income (less than $20,000 annual income) participants were 66 percent less likely to have received a referral than those of higher incomes, and the reported rate of referral was lower for African-American women (12 percent) versus white women (24 percent). Only 15 percent of all women — nine African-American and 26 white — reported enrollment in rehabilitation.

Among the most common reasons cited by patients for not entering rehabilitation programs — particularly by African-American women — was the lack of a referral or follow-up after discharge. Other reasons included feeling too sick, believing that they either did not need rehabilitation or could exercise on their own or being too busy to attend. More than half (51 percent) of the women knew nothing about cardiac rehabilitation. Transportation and cost were not cited as barriers to enrollment.

The study, one of the largest women-only examinations of potential disparities by race in cardiac rehabilitation referral and rehabilitation, confirms trends that have been observed in studies that included a predominance of white and male patients. Lead researcher Allen noted, "As we have found in other studies, a referral or recommendation from a health professional remains a consistently important predictor of enrollment in cardiac rehabilitation. The good news in our study is that the majority (80 percent) of our participants who received information about cardiac rehabilitation from a health care professional also reported enrolling.

"This research and future studies can improve our success rate," Allen said. "When we understand the reasons why low-income and African-American women seem to receive less aggressive referral and participate less often in programs, we can propose the solutions."

The study was co-authored by Lisa Benz Scott, Kerry J. Stewart and Deborah Rohm Young and was supported with funding from the Centers for Disease Control and Prevention.


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