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The Association of Income with Health Behavior Change and Disease Monitoring among Patients with Chronic Disease

Author

Listed:
  • David JT Campbell
  • Paul E Ronksley
  • Braden J Manns
  • Marcello Tonelli
  • Claudia Sanmartin
  • Robert G Weaver
  • Deirdre Hennessy
  • Kathryn King-Shier
  • Tavis Campbell
  • Brenda R Hemmelgarn
  • for the Interdisciplinary Chronic Disease Collaboration

Abstract

Background: Management of chronic diseases requires patients to adhere to recommended health behavior change and complete tests for monitoring. While studies have shown an association between low income and lack of adherence, the reasons why people with low income may be less likely to adhere are unclear. We sought to determine the association between household income and receipt of health behavior change advice, adherence to advice, receipt of recommended monitoring tests, and self-reported reasons for non-adherence/non-receipt. Methods: We conducted a population-weighted survey, with 1849 respondents with cardiovascular-related chronic diseases (heart disease, hypertension, diabetes, stroke) from Western Canada (n = 1849). We used log-binomial regression to examine the association between household income and the outcome variables of interest: receipt of advice for and adherence to health behavior change (sodium reduction, dietary improvement, increased physical activity, smoking cessation, weight loss), reasons for non-adherence, receipt of recommended monitoring tests (cholesterol, blood glucose, blood pressure), and reasons for non-receipt of tests. Results: Behavior change advice was received equally by both low and high income respondents. Low income respondents were more likely than those with high income to not adhere to recommendations regarding smoking cessation (adjusted prevalence rate ratio (PRR): 1.55, 95%CI: 1.09–2.20), and more likely to not receive measurements of blood cholesterol (PRR: 1.72, 95%CI 1.24–2.40) or glucose (PRR: 1.80, 95%CI: 1.26–2.58). Those with low income were less likely to state that non-adherence/non-receipt was due to personal choice, and more likely to state that it was due to an extrinsic factor, such as cost or lack of accessibility. Conclusions: There are important income-related differences in the patterns of health behavior change and disease monitoring, as well as reasons for non-adherence or non-receipt. Among those with low income, adherence to health behavior change and monitoring may be improved by addressing modifiable barriers such as cost and access.

Suggested Citation

  • David JT Campbell & Paul E Ronksley & Braden J Manns & Marcello Tonelli & Claudia Sanmartin & Robert G Weaver & Deirdre Hennessy & Kathryn King-Shier & Tavis Campbell & Brenda R Hemmelgarn & for the I, 2014. "The Association of Income with Health Behavior Change and Disease Monitoring among Patients with Chronic Disease," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-8, April.
    • Handle: RePEc:plo:pone00:0094007
    DOI: 10.1371/journal.pone.0094007
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    References listed on IDEAS

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    1. Marjon Pol & Deirdre Hennessy & Braden Manns, 2017. "The role of time and risk preferences in adherence to physician advice on health behavior change," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(3), pages 373-386, April.
    2. Kim, Hongsoo & Cheng, Shou-Hsia, 2018. "Assessing quality of primary diabetes care in South Korea and Taiwan using avoidable hospitalizations," Health Policy, Elsevier, vol. 122(11), pages 1222-1231.

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