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Int J Rehabil Res. 2005 Sep;28(3):251-7.

Social inequality in patients' physical and psychological state and participation in rehabilitation after myocardial infarction in Germany.

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School of Public Health, University of Bielefeld, Germany.


Several Anglo-American studies found that vertical social characteristics made a difference in the utilization of cardiac rehabilitation programmes. A social gradient was also demonstrated for prevalence of risk factors, psychological strain and psychosocial resources. This study investigated social differences for these factors in a group of 536 patients who had suffered from a myocardial infarction. In contrast to findings in other industrialized countries, German patients of higher status groups made less use of cardiac rehabilitative services than patients with a lower and middle class status. However, similar to Anglo-American findings, patients with a lower socio-economic status were more likely to be smokers and more likely to be obese than other patients. Also they had higher levels of comorbidity and depression and lower self-efficacy expectations. Thus while there were no social disadvantages in terms of participation in cardiac rehabilitation programmes, which seems to be largely due to the specific characteristics of the German health care system, patients of lower socio-economic status seem to have worse baseline conditions and as a result of this a specific need for rehabilitative support.

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