Travel Distance, Urbanicity, and Cardiac Rehabilitation Participation in Medicare Beneficiaries

TL;DR

This study finds that people in rural areas are less likely to participate in cardiac rehabilitation due to longer travel distances compared to those in urban areas.

Contribution

The study quantifies how travel distance and urbanicity affect cardiac rehabilitation participation among Medicare beneficiaries.

Findings

CR enrollment was highest for beneficiaries living in the same zip code as a CR facility and lowest for those 30+ miles away.

Rural beneficiaries living more than 15 miles from a CR facility had significantly lower enrollment and completion rates compared to urban beneficiaries.

The negative impact of travel distance on CR participation was more pronounced in rural areas.

Abstract

Cardiac rehabilitation (CR) is a key intervention for patients recovering from major cardiovascular procedures, but access may be limited.

The purpose of this study was to evaluate the relationship between travel distance to the nearest CR facility, degree of urbanicity, and CR participation.

A retrospective cohort study was conducted on a sample of 100% Medicare fee-for-service claims for beneficiaries with a recent cardiovascular procedure between July 2016 and December 2018. Travel distance between the beneficiary and nearest CR facility was estimated using estimated travel distance between zip codes using Google Maps and categorized as being within the same zip code, 1-15 miles, 16-30 miles, and 30+ miles. Urbanicity was classified as urban, suburban, small town, and rural using U.S. Census data. Multivariable logistic regression compared CR enrollment (attending at least one session) and completion rates (attending 36 sessions or more) across distance and urbanicity categories.

Of the 501,049 beneficiaries in the sample, 76% of urban beneficiaries lived within 15 miles of the nearest CR facility (80,182/84,345), and 63% of rural beneficiaries 15 miles away or more (70,892/112,697). CR enrollment was highest among beneficiaries living within the same zip code as a CR facility (45.6%, 53,935/118,642) and lowest among those living 30 or more miles from the nearest CR facility (19.5%, 7,462/38,309), with an adjusted difference of −22.6 (95% CI: −23.1 to −22.0; P < 0.001). In rural areas, the effect of travel distance on CR enrollment and completion was significantly greater when compared with individuals in urban areas.

Increased travel distance was associated with lower overall CR participation, with the effect varying by local degree of urbanicity.

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