Differences in Post-Cardiac Rehabilitation Quality of Life in Western Sydney by Country of Birth, Employment Status, Socioeconomic Status of Area of Residence, and Remoteness of Area of Residence

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BACKGROUND: Cardiac rehabilitation improves recovery after cardiovascular events, but changes in health-related quality of life (HRQoL) may differ by socio-economic subgroups. This study investigated whether changes in HRQoL differed by country of birth, employment status, socio-economic status of area of residence, and remoteness. METHOD: Data were analysed from individuals who completed pre- and post-program assessments at a publicly funded cardiac rehabilitation program in Western Sydney, Australia. Changes in domain scores of the 36-Item Short Form Health Survey (SF-36) were assessed using multivariable linear regression with robust standard errors. False discovery rate (FDR) correction was applied across nine models for each socio-economic characteristic. RESULTS: Of 11,695 individuals referred (mean age, 61 years; standard deviation [SD], 12; 78% male), 6,461 (55%) completed the program and 4,918 (42%) completed both HRQoL assessments (mean age, 61 years; SD, 11; 80% male). Being born overseas (vs Australia) was associated with more modest improvement in Health Transition. Being retired or unemployed (vs employed) was associated with more modest improvement across Physical Functioning, Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role Emotional, and Mental Health. Socio-economic status of area was not associated with differences in change. Residing in inner or outer regional areas (vs major cities) was associated with more modest improvement in Role Physical, while residing in remote or very remote areas was associated with more modest improvement in Role Physical and Role Emotional. CONCLUSIONS: HRQoL improved across all domains, but improvements were more modest among individuals who were born overseas, unemployed, or retired, and those residing in regional or remote areas. Programs may need to strengthen culturally adapted resources and extend flexible delivery to support more equitable recovery.

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