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. 2025 Sep 27:qcaf114.
doi: 10.1093/ehjqcco/qcaf114. Online ahead of print.

Inequality Across the Cardiac Rehabilitation Trajectory in Denmark: Investigating Key Sociodemographic and Health-Related Drivers

Ida Pedersen Halvorsen  1 , Maria Kristiansen  2 , Volkert Siersma  3 , Michaela Louise Schiøtz  1   4 , Nina Føns Johnsen  4 , Sidsel Marie Bernt Jørgensen  4 , Hanne Birke  1
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Inequality Across the Cardiac Rehabilitation Trajectory in Denmark: Investigating Key Sociodemographic and Health-Related Drivers

Ida Pedersen Halvorsen et al. Eur Heart J Qual Care Clin Outcomes. .

Abstract

Aim: 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.

Methods: We conducted a survey- and register-based cohort study that combined data from a nationwide patient survey and Danish registries. A total of 5,375 (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.

Results: The key drivers of inequality in being offered CR were age, type of CVD, and occupational status, with older adults (≥76 years) and those with ischemic 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 participating in CR, with those residing in rural municipalities and individuals born in a non-Western country significantly less likely to participate.

Conclusion: 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.

Keywords: cardiac rehabilitation; cardiovascular disease; inequality; person-centred care; rehabilitation trajectory.

Plain language summary

This study looked at which personal, social, and health-related factors matters most in creating differences in peoples’ cardiac rehabilitation (CR) journey. Age, type of heart disease, and job situation were the biggest factors in whether a person was offered cardiac rehabilitation.Where a person lives, income, and education level were the biggest factors in whether a person accepted cardiac rehabilitation. For participation, the most important factors were where a person lives, country of birth, and age.

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