{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T13:41:19Z","timestamp":1786542079443,"version":"build-2736575974"},"reference-count":25,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009477","name":"New Zealand Lotteries Commission Translational Health Research Projects Fund","doi-asserted-by":"publisher","award":["PN3725156"],"award-info":[{"award-number":["PN3725156"]}],"id":[{"id":"10.13039\/501100009477","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Te Punaha Matatini and P\u016btahi Manawa Centres of Research Excellence"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Ethnic inequities in cardiovascular disease and healthcare access are well recognised worldwide, but it is unclear whether these inequities translate into differences in cardiac rehabilitation participation and subsequent clinical outcomes. This study examined ethnic differences in cardiac rehabilitation enrolment, participation, and mortality outcomes within a large multi-ethnic cohort to determine whether the association between rehabilitation exposure and mortality differed across ethnic groups. Methods: This retrospective cohort study included 4940 consecutive patients referred to the Auckland cardiac rehabilitation programme between 2016 and 2023. Baseline characteristics, rehabilitation participation, and all-cause mortality were examined across ethnic groups. Associations with mortality were assessed using multivariable Cox proportional hazards models adjusted for demographic and clinical risk factors. Results: During a median follow-up of 5.6 years, 565 deaths occurred. Cardiac rehabilitation participation differed across ethnic groups (p &lt; 0.001), with lowest participation among Pacific patients (44.3%) and highest participation among Asian patients (58.6%). Among attenders, total session attendance was similar across ethnic groups (p = 0.35). After adjustment, mortality risk was lower among Asian patients (HR 0.58, 95% CI 0.46\u20130.74, p &lt; 0.001), but did not differ for M\u0101ori (HR 1.21, 95% CI 0.86\u20131.71) or Pacific patients (HR 1.03, 95% CI 0.79\u20131.36) compared with Europeans. Greater rehabilitation exposure was associated with lower mortality (HR 0.98 per session, 95% CI 0.97\u20130.99, p = 0.002), and no interaction between ethnicity and rehabilitation exposure was observed. Conclusions: Ethnic differences in cardiac rehabilitation were evident at the level of enrolment, but not in session exposure among attenders or in the association between rehabilitation participation and mortality. This study highlights the importance of distinguishing inequities in access and engagement from the effectiveness of rehabilitation once delivered.<\/jats:p>","DOI":"10.3390\/jcm15166247","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T12:53:48Z","timestamp":1786539228000},"page":"6247","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ethnic Differences in Cardiac Rehabilitation Enrolment, Participation, and Mortality: A Retrospective Cohort Study from Auckland, New Zealand"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1631-1925","authenticated-orcid":false,"given":"Paul W.","family":"Marshall","sequence":"first","affiliation":[{"name":"School of Exercise, Sport and Rehabilitation Sciences, Faculty of Sciences, University of Auckland, Auckland 1142, New Zealand"},{"name":"Centre for Health and Rehabilitation Research, Faculty of Sciences, University of Auckland, Auckland 1142, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alana","family":"McCambridge","sequence":"additional","affiliation":[{"name":"Person Centred Rehabilitation Research Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland 1142, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4109-3900","authenticated-orcid":false,"given":"Sasha","family":"Douglas","sequence":"additional","affiliation":[{"name":"School of Exercise, Sport and Rehabilitation Sciences, Faculty of Sciences, University of Auckland, Auckland 1142, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tia","family":"Kendal-Lindbom","sequence":"additional","affiliation":[{"name":"School of Exercise, Sport and Rehabilitation Sciences, Faculty of Sciences, University of Auckland, Auckland 1142, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy","family":"Marshall","sequence":"additional","affiliation":[{"name":"Greenlane Cardiovascular Services, Auckland City Hospital, Auckland 1142, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5621-4206","authenticated-orcid":false,"given":"Michael","family":"O\u2019Sullivan","sequence":"additional","affiliation":[{"name":"Department of Engineering Science and Biomedical Engineering, University of Auckland, Auckland 1142, New Zealand"},{"name":"Te P\u016bnaha Matatini, Centre of Research Excellence, University of Auckland, Auckland 1142, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1682-4024","authenticated-orcid":false,"given":"Gayatri","family":"Ganesh","sequence":"additional","affiliation":[{"name":"Department of Engineering Science and Biomedical Engineering, University of Auckland, Auckland 1142, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cameron","family":"Walker","sequence":"additional","affiliation":[{"name":"Department of Engineering Science and Biomedical Engineering, University of Auckland, Auckland 1142, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1663-2195","authenticated-orcid":false,"given":"Nikki J.","family":"Earle","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey","family":"Reading","sequence":"additional","affiliation":[{"name":"School of Exercise, Sport and Rehabilitation Sciences, Faculty of Sciences, University of Auckland, Auckland 1142, New Zealand"},{"name":"Centre for Health and Rehabilitation Research, Faculty of Sciences, University of Auckland, Auckland 1142, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6724-8997","authenticated-orcid":false,"given":"Jocelyne","family":"Benatar","sequence":"additional","affiliation":[{"name":"Greenlane Cardiovascular Services, Auckland City Hospital, Auckland 1142, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1953-4067","authenticated-orcid":false,"given":"Michael","family":"Kingsley","sequence":"additional","affiliation":[{"name":"School of Exercise, Sport and Rehabilitation Sciences, Faculty of Sciences, University of Auckland, Auckland 1142, New Zealand"},{"name":"Centre for Health and Rehabilitation Research, Faculty of Sciences, University of Auckland, Auckland 1142, New Zealand"},{"name":"Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Melbourne, VIC 3552, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"ref_1","unstructured":"Ministry of Health (2023). 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