{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T22:14:11Z","timestamp":1791670451439,"version":"4.3.4"},"reference-count":46,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,10,21]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">There is a dearth of research examining geographic disparities in access to cardiac rehabilitation (CR). We evaluated whether disparities in geographic access to CR exist among socially vulnerable communities, using the Social Vulnerability Index (SVI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">Among 3113 US counties, we investigated relationships between SVI and number of hospitals with CR per 100\u2009000 adults, modeled with SVI as a linear variable, and SVI and distance to the nearest county with CR facilities, modeled using spline terms for SVI. We used multivariable zero\u2010inflated negative binomial regression modeling adjusted for county population, CR eligibility, percentage without health insurance, metropolitan status, and availability of existing health care infrastructure. We explored whether these relationships changed in the context of rurality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      After adjustment, as SVI increased by 1 percentile, number of hospitals with CR per 100\u2009000 adults decreased by 1.2% (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). For distance to CR, individual spline terms were not significant in our adjusted model; however, the overall predicted distance to CR increased as SVI increased. When stratified by metropolitan status, these relationships not only persisted but also intensified in rural counties. As SVI increased by 1 percentile, the odds of a county containing a CR facility decreased by 0.9% in metropolitan counties (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.002) versus 2.2% in rural counties (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p xml:lang=\"en\">More socially vulnerable communities experienced worse geographic access to CR facilities. This access disparity intensified in rural communities. Our findings call for reducing barriers to CR access among socially vulnerable and rural communities, potentially through virtual or hybrid models of CR.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.124.040815","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T12:10:36Z","timestamp":1760011836000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Disparities in Geographic Access to Cardiac Rehabilitation Among Socially Vulnerable Communities"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9358-6183","authenticated-orcid":false,"given":"Edward W.","family":"Chen","sequence":"first","affiliation":[{"name":"Yale School of Medicine","place":["New Haven, USA"]},{"name":"VA Connecticut Healthcare System","place":["West Haven, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2834-2024","authenticated-orcid":false,"given":"Wen\u2010Chih","family":"Wu","sequence":"additional","affiliation":[{"name":"Cardiovascular Rehabilitation Center","place":["Providence, USA"]},{"name":"Brown University","place":["Providence, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3168-9002","authenticated-orcid":false,"given":"Ling","family":"Han","sequence":"additional","affiliation":[{"name":"Yale School of Medicine","place":["New Haven, USA"]},{"name":"VA Connecticut Healthcare System","place":["West Haven, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parul U.","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Yale School of Medicine","place":["New Haven, USA"]},{"name":"VA Connecticut Healthcare System","place":["West Haven, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lori A.","family":"Bastian","sequence":"additional","affiliation":[{"name":"Yale School of Medicine","place":["New Haven, USA"]},{"name":"VA Connecticut Healthcare System","place":["West Haven, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8179-1796","authenticated-orcid":false,"given":"Cynthia A.","family":"Brandt","sequence":"additional","affiliation":[{"name":"Yale School of Medicine","place":["New Haven, USA"]},{"name":"VA Connecticut Healthcare System","place":["West Haven, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin M.","family":"Mattocks","sequence":"additional","affiliation":[{"name":"VA Central Western Massachusetts Healthcare System","place":["Leeds, USA"]},{"name":"University of Massachusetts Medical School","place":["Worcester, 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