{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:50:55Z","timestamp":1791420655471,"version":"4.3.3"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T00:00:00Z","timestamp":1758931200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100009708","name":"Novo Nordisk Fonden","doi-asserted-by":"publisher","award":["NNF22OC0076979"],"award-info":[{"award-number":["NNF22OC0076979"]}],"id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010303","name":"Anita og Tage Therkelsens Fond","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010303","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To investigate the key sociodemographic and health-related drivers of inequality across the cardiac rehabilitation (CR) trajectory, to advance understanding of the underlying factors shaping inequality in CR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We conducted a survey- and register-based cohort study that combined data from a nationwide patient survey and Danish registries. A total of 5375 (53.8%) individuals diagnosed with cardiovascular disease (CVD) in 2018 responded to survey. Dominance analyses and multivariable logistic regression analyses were performed to examine the association of multiple sociodemographic and health-related factors on being offered, accepting, and participating in CR. The key drivers of inequality in being offered CR were age, type of CVD, and occupational status, with older adults (\u226576 years) and those with ischaemic heart disease (IHD) significantly less likely to receive an offer. Municipality group, educational level and family income were the key drivers of inequality in accepting CR, with individuals of a low family income significantly less likely to accept. Municipality group, country of birth and age were the key drivers of inequality for CR participation, with those residing in rural municipalities and individuals born in a non-Western country significantly less likely to participate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Age, type of CVD, municipality group, socioeconomic factors (occupational status, education level and family income) and country of birth was identified as the key drivers of inequality across the CR trajectory, with their influence varying at each CR phase. The results of this study can inform the development of future person-centred care (PCC) strategies to ensure more equitable CR.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjqcco\/qcaf114","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T11:28:39Z","timestamp":1758540519000},"page":"1474-1484","source":"Crossref","is-referenced-by-count":2,"title":["Inequality across the cardiac rehabilitation trajectory in Denmark: investigating key sociodemographic and health-related drivers"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7566-1343","authenticated-orcid":false,"given":"Ida Pedersen","family":"Halvorsen","sequence":"first","affiliation":[{"name":"Center for Clinical Research and Prevention, Frederiksberg Hospital , 2000 Frederiksberg ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2319-3637","authenticated-orcid":false,"given":"Maria","family":"Kristiansen","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Copenhagen , 1353 Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1941-2681","authenticated-orcid":false,"given":"Volkert","family":"Siersma","sequence":"additional","affiliation":[{"name":"Department of Public Health, The Research Unit for General Practice and Section of General Practice, University of Copenhagen , 1353 Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2575-6686","authenticated-orcid":false,"given":"Michaela Louise","family":"Schi\u00f8tz","sequence":"additional","affiliation":[{"name":"Center for Clinical Research and Prevention, Frederiksberg Hospital , 2000 Frederiksberg ,","place":["Denmark"]},{"name":"Department of Public Health, Research Unit of General Practice, University of Southern Denmark , 5000 Odense ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6272-0730","authenticated-orcid":false,"given":"Nina F\u00f8ns","family":"Johnsen","sequence":"additional","affiliation":[{"name":"Danish Heart Association , 1120 Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7135-7168","authenticated-orcid":false,"given":"Sidsel Marie Bernt","family":"J\u00f8rgensen","sequence":"additional","affiliation":[{"name":"Danish Heart Association , 1120 Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5923-2170","authenticated-orcid":false,"given":"Hanne","family":"Birke","sequence":"additional","affiliation":[{"name":"Center for Clinical Research and Prevention, Frederiksberg Hospital , 2000 Frederiksberg ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,9,27]]},"reference":[{"key":"2025121818523032200_qcaf114-B1","doi-asserted-by":"crossref","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","article-title":"Global burden of cardiovascular diseases and risk factors, 1990\u20132019: update from the GBD 2019 study","volume":"76","author":"Roth","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2025121818523032200_qcaf114-B2","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1093\/eurjpc\/zwae281","article-title":"Global burden of cardiovascular diseases: projections from 2025 to 2050","volume":"32","author":"Chong","year":"2024","journal-title":"Eur J Prev Cardiol"},{"key":"2025121818523032200_qcaf114-B3","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1093\/eurheartj\/ehab892","article-title":"European Society of Cardiology: cardiovascular disease statistics 2021","volume":"43","author":"Timmis","year":"2022","journal-title":"Eur Heart J"},{"key":"2025121818523032200_qcaf114-B4","doi-asserted-by":"crossref","first-page":"3227","DOI":"10.1093\/eurheartj\/ehab484","article-title":"2021 ESC guidelines on cardiovascular disease prevention in clinical practice","volume":"42","author":"Visseren","year":"2021","journal-title":"Eur Heart J"},{"key":"2025121818523032200_qcaf114-B5","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1177\/2047487320913379","article-title":"Secondary prevention through comprehensive cardiovascular rehabilitation: from knowledge to implementation. 2020 update. A position paper from the secondary prevention and rehabilitation section of the European Association of Preventive Cardiology","volume":"28","author":"Ambrosetti","year":"2021","journal-title":"Eur J Prev Cardiol"},{"key":"2025121818523032200_qcaf114-B6","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1038\/s41569-021-00611-7","article-title":"The role of cardiac rehabilitation in improving cardiovascular outcomes","volume":"19","author":"Taylor","year":"2022","journal-title":"Nat Rev Cardiol"},{"key":"2025121818523032200_qcaf114-B7","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1177\/2047487319827453","article-title":"Cardiac rehabilitation availability and delivery in Europe: how does it differ by region and compare with other high-income countries?: Endorsed by the European Association of Preventive Cardiology","volume":"26","author":"Abreu","year":"2019","journal-title":"Eur J Prev Cardiol"},{"key":"2025121818523032200_qcaf114-B8","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s40119-020-00164-9","article-title":"The beneficial effects of cardiac rehabilitation","volume":"9","author":"Bellmann","year":"2020","journal-title":"Cardiol Ther"},{"key":"2025121818523032200_qcaf114-B9","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1097\/HJR.0b013e328334f42d","article-title":"Cardiac rehabilitation in Europe: results from the European cardiac rehabilitation inventory survey","volume":"17","author":"Bjarnason-Wehrens","year":"2010","journal-title":"Eur J Cardiovasc Prev Rehabil"},{"key":"2025121818523032200_qcaf114-B10","first-page":"1","article-title":"Exercise-based cardiac rehabilitation for coronary heart disease","volume":"11","author":"Dibben","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121818523032200_qcaf114-B11","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1177\/2047487318781359","article-title":"Determinants of participation and risk factor control according to attendance in cardiac rehabilitation programmes in coronary patients in Europe: EUROASPIRE IV survey","volume":"25","author":"Kotseva","year":"2018","journal-title":"Eur J Prev Cardiol"},{"key":"2025121818523032200_qcaf114-B12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijcard.2018.01.096","article-title":"Referral for cardiac rehabilitation after acute myocardial infarction: insights from nationwide AMIS plus registry 2005\u20132017","volume":"261","author":"Hermann","year":"2018","journal-title":"Int J Cardiol"},{"key":"2025121818523032200_qcaf114-B13","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1093\/eurjpc\/zwaa104","article-title":"Offering, participation and adherence to cardiac rehabilitation programmes in the elderly: a European comparison based on the EU-CaRE multicentre observational study","volume":"28","author":"Gonz\u00e1lez-Salvado","year":"2021","journal-title":"Eur J Prev Cardiol"},{"key":"2025121818523032200_qcaf114-B14","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1093\/eurjpc\/zwab204","article-title":"Clinical outcomes and cardiac rehabilitation in underrepresented groups after percutaneous coronary intervention: an observational study","volume":"29","author":"Gonzalez-Jaramillo","year":"2022","journal-title":"Eur J Prev Cardiol"},{"key":"2025121818523032200_qcaf114-B15","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.ijcard.2016.08.120","article-title":"Participation and adherence to cardiac rehabilitation programs. A systematic review","volume":"223","author":"Ruano-Ravina","year":"2016","journal-title":"Int J Cardiol"},{"key":"2025121818523032200_qcaf114-B16","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s12471-020-01492-0","article-title":"Predictors of cardiac rehabilitation referral, enrolment and completion after acute myocardial infarction: an exploratory study","volume":"29","author":"Brouwers","year":"2021","journal-title":"Neth Heart J"},{"key":"2025121818523032200_qcaf114-B17","doi-asserted-by":"crossref","first-page":"e0276768","DOI":"10.1371\/journal.pone.0276768","article-title":"Socioeconomic and ethnical disparity in coronary heart disease outcomes in Denmark and the effect of cardiac rehabilitation\u2014a nationwide registry study","volume":"17","author":"Kjesbu","year":"2022","journal-title":"PLoS One"},{"key":"2025121818523032200_qcaf114-B18","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1177\/2047487314520783","article-title":"Sex bias in referral of women to outpatient cardiac rehabilitation? A meta-analysis","volume":"22","author":"Colella","year":"2015","journal-title":"Eur J Prev Cardiol"},{"key":"2025121818523032200_qcaf114-B19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s40615-018-0478-x","article-title":"Disparities in cardiac rehabilitation among individuals from racial and ethnic groups and rural communities\u2014a systematic review","volume":"6","author":"Castellanos","year":"2019","journal-title":"J Racial Ethn Health Disparities"},{"key":"2025121818523032200_qcaf114-B20","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1097\/HCR.0000000000000858","article-title":"Temporal trends in cardiac rehabilitation participation and its core components: a nationwide cohort study from The Netherlands","volume":"44","author":"Vonk","year":"2024","journal-title":"J Cardiopulm Rehabil Prev"},{"key":"2025121818523032200_qcaf114-B21","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1177\/1474515117737766","article-title":"Cardiac rehabilitation after percutaneous coronary intervention: results from a nationwide survey","volume":"17","author":"Olsen","year":"2018","journal-title":"Eur J Cardiovasc Nurs"},{"key":"2025121818523032200_qcaf114-B22","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1097\/PHM.0000000000002270","article-title":"Socioeconomic inequalities and predictors of cardiac rehabilitation referral: real-world evidence","volume":"102","author":"Rocha","year":"2023","journal-title":"Am J Phys Med Rehabil"},{"key":"2025121818523032200_qcaf114-B23","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1177\/1474515117746011","article-title":"Social inequality in phase II cardiac rehabilitation attendance: the impact of potential mediators","volume":"17","author":"Pedersen","year":"2018","journal-title":"Eur J Cardiovasc Nurs"},{"key":"2025121818523032200_qcaf114-B24","doi-asserted-by":"crossref","first-page":"e060924","DOI":"10.1136\/bmjopen-2022-060924","article-title":"To what extend is socioeconomic status associated with not taking up and dropout from cardiac rehabilitation: a population-based follow-up study","volume":"12","author":"Svendsen","year":"2022","journal-title":"BMJ Open"},{"key":"2025121818523032200_qcaf114-B25","volume-title":"National klinisk retningslinje for hjerterehabilitering","author":"Sundhedsstyrelsen","year":"2015"},{"key":"2025121818523032200_qcaf114-B26","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1186\/s12889-022-13494-1","article-title":"Perceived return-to-work pressure following cardiovascular disease is associated with age, sex, and diagnosis: a nationwide combined survey- and register-based cohort study","volume":"22","author":"Bernt J\u00f8rgensen","year":"2022","journal-title":"BMC Public Health"},{"key":"2025121818523032200_qcaf114-B27","doi-asserted-by":"crossref","first-page":"2893","DOI":"10.1093\/eurheartj\/ehw210","article-title":"2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS","volume":"37","author":"Kirchhof","year":"2016","journal-title":"Eur Heart J"},{"key":"2025121818523032200_qcaf114-B28","doi-asserted-by":"crossref","first-page":"e000880","DOI":"10.1136\/openhrt-2018-000880","article-title":"Exercise-based cardiac rehabilitation improves exercise capacity and health-related quality of life in people with atrial fibrillation: a systematic review and meta-analysis of randomised and non-randomised trials","volume":"5","author":"Smart","year":"2018","journal-title":"Open Heart"},{"key":"2025121818523032200_qcaf114-B29","doi-asserted-by":"crossref","first-page":"563","DOI":"10.2147\/CLEP.S179083","article-title":"The Danish health care system and epidemiological research: from health care contacts to database records","volume":"11","author":"Schmidt","year":"2019","journal-title":"Clin Epidemiol"},{"key":"2025121818523032200_qcaf114-B30","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1177\/1403494810387965","article-title":"The Danish civil registration system","volume":"39","author":"Pedersen","year":"2011","journal-title":"Scand J Public Health"},{"key":"2025121818523032200_qcaf114-B31","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1177\/1403494810394715","article-title":"Danish education registers","volume":"39","author":"Jensen","year":"2011","journal-title":"Scand J Public Health"},{"key":"2025121818523032200_qcaf114-B32","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1177\/1403494811405098","article-title":"Danish registers on personal income and transfer payments","volume":"39","author":"Baadsgaard","year":"2011","journal-title":"Scand J Public Health"},{"key":"2025121818523032200_qcaf114-B33","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1177\/1403494811401482","article-title":"The Danish national patient register","volume":"39","author":"Lynge","year":"2011","journal-title":"Scand J Public Health"},{"key":"2025121818523032200_qcaf114-B34","volume-title":"Municipality Groups","author":"Statistics Denmark"},{"key":"2025121818523032200_qcaf114-B35","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1177\/096228029600500303","article-title":"The use of sampling weights for survey data analysis","volume":"5","author":"Pfeffermann","year":"1996","journal-title":"Stat Methods Med Res"},{"key":"2025121818523032200_qcaf114-B36","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s12170-018-0569-6","article-title":"Cardiac rehabilitation in older persons with cardiovascular disease","volume":"12","author":"Goldstein","year":"2018","journal-title":"Curr Cardiovasc Risk Rep"},{"key":"2025121818523032200_qcaf114-B37","doi-asserted-by":"crossref","first-page":"e036088","DOI":"10.1136\/bmjopen-2019-036088","article-title":"Influence of socioeconomic status on the referral process to cardiac rehabilitation following acute coronary syndrome: a cross-sectional study","volume":"10","author":"Graversen","year":"2020","journal-title":"BMJ Open"},{"key":"2025121818523032200_qcaf114-B38","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1097\/HCR.0000000000000659","article-title":"A review of disparities in cardiac rehabilitation: evidence, drivers, and solutions","volume":"41","author":"Mathews","year":"2021","journal-title":"J Cardiopulm Rehabil Prev"},{"key":"2025121818523032200_qcaf114-B39","doi-asserted-by":"crossref","first-page":"339","DOI":"10.3390\/ijerph21030339","article-title":"Barriers to cardiac rehabilitation among patients diagnosed with cardiovascular diseases\u2014a scoping review","volume":"21","author":"Iyngkaran","year":"2024","journal-title":"Int J Environ Res Public Health"},{"key":"2025121818523032200_qcaf114-B40","doi-asserted-by":"crossref","first-page":"757","DOI":"10.3390\/healthcare11050757","article-title":"Ethnic minorities\u2019 experiences of cardiac rehabilitation: a scoping review","volume":"11","author":"Carew Tofani","year":"2023","journal-title":"Healthcare"},{"key":"2025121818523032200_qcaf114-B41","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1186\/s12913-019-4041-1","article-title":"Access to cardiac rehabilitation and the role of language barriers in the provision of cardiac rehabilitation to migrants","volume":"19","author":"Al-Sharifi","year":"2019","journal-title":"BMC Health Serv Res"},{"key":"2025121818523032200_qcaf114-B42","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/jgs.13866","article-title":"Person-centered care: a definition and essential elements","volume":"64","author":"American Geriatrics Society Expert Panel on Person-Centered Care","year":"2016","journal-title":"J Am Geriatr Soc"},{"key":"2025121818523032200_qcaf114-B43","doi-asserted-by":"crossref","first-page":"e048558","DOI":"10.1136\/bmjopen-2020-048558","article-title":"Systematic review of patient-engagement interventions: potentials for enhancing person-centred care for older patients with multimorbidity","volume":"11","author":"S\u00f8gaard","year":"2021","journal-title":"BMJ Open"},{"key":"2025121818523032200_qcaf114-B44","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1186\/1475-9276-12-72","article-title":"Cardiac rehabilitation barriers by rurality and socioeconomic status: a cross-sectional study","volume":"12","author":"Shanmugasegaram","year":"2013","journal-title":"Int J Equity Health"},{"key":"2025121818523032200_qcaf114-B45","doi-asserted-by":"crossref","first-page":"e012832","DOI":"10.1136\/bmjopen-2016-012832","article-title":"Positive predictive value of cardiovascular diagnoses in the Danish national patient registry: a validation study","volume":"6","author":"Sundb\u00f8ll","year":"2016","journal-title":"BMJ Open"},{"key":"2025121818523032200_qcaf114-B46","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1093\/eurjpc\/zwac249","article-title":"Diagnostic group differences in return to work and subsequent detachment from employment following cardiovascular disease: a nationwide cohort study","volume":"30","author":"Bernt J\u00f8rgensen","year":"2023","journal-title":"Eur J Prev Cardiol"},{"key":"2025121818523032200_qcaf114-B47","doi-asserted-by":"crossref","first-page":"667","DOI":"10.2105\/AJPH.2023.307267","article-title":"Decreasing survey response rates in the time of COVID-19: implications for analyses of population health and health inequities","volume":"113","author":"Krieger","year":"2023","journal-title":"Am J Public Health"}],"container-title":["European Heart Journal - Quality of Care and Clinical Outcomes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjqcco\/advance-article-pdf\/doi\/10.1093\/ehjqcco\/qcaf114\/64417035\/qcaf114.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article-pdf\/11\/8\/1474\/64417035\/qcaf114.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article-pdf\/11\/8\/1474\/64417035\/qcaf114.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T23:52:45Z","timestamp":1766101965000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjqcco\/article\/11\/8\/1474\/8266660"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,27]]},"references-count":47,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,9,27]]},"published-print":{"date-parts":[[2025,12,19]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjqcco\/qcaf114","relation":{},"ISSN":["2058-5225","2058-1742"],"issn-type":[{"value":"2058-5225","type":"print"},{"value":"2058-1742","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12]]},"published":{"date-parts":[[2025,9,27]]}}}