Financial strain is associated with medication nonadherence and worse self-rated health among cardiovascular patients

Osborn, Chandra Y.; Kripalani, Sunil; Goggins, Kathryn; Wallston, Kenneth A.

doi:10.1353/hpu.2017.0036

Cited by 55 publications

(30 citation statements)

References 35 publications

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“…Our results regarding the separate associations for SES and PA in relation to SRH are in line with earlier studies that have shown that PA is related to better SRH [20] and that economic problems are associated with poorer SRH [36, 37]. However, to our knowledge, this is the first study to illustrate that PA may compensate for SES with regard to SRH and QoL in these age groups.…”

Section: Discussionsupporting

confidence: 91%

Can physical activity compensate for low socioeconomic status with regard to poor self-rated health and low quality-of-life?

Johansson

Lingfors

Golsäter

et al. 2019

Health Qual Life Outcomes

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BackgroundBoth high socioeconomic status (SES) and high physical activity (PA) are associated with better self-rated health (SRH) and higher quality-of-life (QoL).AimTo investigate whether high levels of PA may compensate for the association between low SES and subjective health outcomes in terms of poorer SRH and lower QoL.MethodData from a cross-sectional, population-based study (n = 5326) was utilized. Multiple logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between indicators of SES (economic situation and educational level), SRH and QoL, as well as between the combination of SES and PA in relation to SRH and QoL.ResultParticipants with high PA and economic problems had approximately the same OR for good SRH as those with low PA and without economic problems (OR 1.75 [95% CI 1.20–2.54] and 1.81 [1.25–2.63] respectively). Participants with high PA and low education had higher odds for good SRH (OR 3.34 [2.96–5.34] compared to those with low PA and high education (OR 1.46 [0.89–2.39]).Those with high PA and economic problems had an OR of 2.09 [1.42–3.08], for high QoL, while the corresponding OR for those with low PA and without economic problems was 4.38 [2.89–6.63].ConclusionPhysically active people with low SES, had the same or even better odds to report good SRH compared to those with low PA and high SES. For QoL the result was not as consistent. The findings highlight the potential for promotion of PA to reduce SES-based inequalities in SRH.Electronic supplementary materialThe online version of this article (10.1186/s12955-019-1102-4) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 91%

Can physical activity compensate for low socioeconomic status with regard to poor self-rated health and low quality-of-life?

Johansson

Lingfors

Golsäter

et al. 2019

Health Qual Life Outcomes

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“…Participant-reported indicators of SES included employment status (3-level categorical variable: employed full- or part-time, disabled or, referent, able to work but not working), financial strain, household income, and insurance status (dichotomized: underinsured, including uninsured or public insurance only, versus adequately insured). Financial strain was assessed using a single question, “How difficult is it for you (and your family) to pay your monthly bills?,” 35 analyzed as a continuous variable with higher scores reflecting greater difficulty. Household income was assessed with modified strata from the Behavioral Risk Factor Surveillance System questionnaire.…”

Section: Methodsmentioning

confidence: 99%

Health Literacy and 1-Year Mortality: Mechanisms of Association in Adults Hospitalized for Cardiovascular Disease

Mayberry

Schildcrout

Wallston

et al. 2018

Mayo Clinic Proceedings

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Objective: To test theorized patient-level mediators in the causal pathway between health literacy (HL) and 1-year mortality among adults with cardiovascular disease (CVD) Patients and Methods: 3,000 adults treated at Vanderbilt University Hospital from October 11, 2011 to December 18, 2015 for acute coronary syndrome or acute decompensated heart failure (ADHF) participated in the Vanderbilt Inpatient Cohort Study. Participants completed a bed-side administered survey and consented to health record review and longitudinal follow-up. Multivariable mediation models examined the direct and indirect effects of HL (a latent variable with 4 indicators) with 1-year mortality post-discharge (dichotomous). Hypothesized mediators included social support, health competence, health behavior, comorbidity index, type of CVD diagnosis, and prior year hospitalizations. Results: Of the 2,977 patients discharged from the hospital (60% male, mean age 61 years, 83% non-Hispanic White, 37% admitted for ADHF), 17–23% had inadequate HL depending on measure, and 10% died within 1 year. The total effect of lower HL on 1-year mortality (AOR=1.31 [95% CI, 1.01, 1.69]) was decomposed into an indirect effect (AOR=1.50 [1.35, 1.67]) via the mediators and a nonsignificant direct effect (AOR=0.87 [CI, 0.66, 1.14]). Each standard deviation decrease in HL was associated with an absolute 3.2 percentage point increase in the probability of 1-year mortality via mediators admitted for ADHF, comorbidities, health behavior, health competence, and prior hospitalizations (by contribution to indirect effect). Conclusion: Patient-level factors drive the relationship between low HL and mortality. Health competence and health behavior are modifiable mediators that could be targeted by interventions.

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“… 33 The differences found between high-improvement and nonimprovement groups suggest the influence of socioeconomic status on participants’ efforts to lower LDLC levels, consistent with prior research on medication adherence. 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 Socioeconomic status is a complex collection of factors, including income, wealth, educational attainment, occupation, location, and social capital. Participants in the high-improvement group were more likely to be employed, evinced greater health literacy and engagement, had better access to healthy food at work and work schedules more amenable to healthy eating, were more able to make specific dietary changes, and had less difficulty establishing medication routines.…”

Section: Discussionmentioning

confidence: 99%

Qualitative Exploration of Barriers to Statin Adherence and Lipid Control

et al. 2021

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Key Points Question What barriers to statin therapy adherence and control of cholesterol levels are revealed through qualitative interviews with participants in a randomized trial of financial incentives for adherence? Findings In this qualitative study of 54 participants, individuals whose cholesterol levels did not improve described a greater burden of chronic illness, were less frequently employed, were less focused on the risks of high cholesterol levels, appeared to have lower health literacy, were less engaged in their cholesterol level management, made fewer specific nutritional choices for optimizing health, and had greater difficulty obtaining healthy food compared with participants with marked improvement of cholesterol levels. Meaning These findings suggest that future interventions should consider addressing socioeconomic circumstances in combination with adherence interventions among patients needing to reduce cholesterol levels.

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Financial strain is associated with medication nonadherence and worse self-rated health among cardiovascular patients

Cited by 55 publications

References 35 publications

Can physical activity compensate for low socioeconomic status with regard to poor self-rated health and low quality-of-life?

Can physical activity compensate for low socioeconomic status with regard to poor self-rated health and low quality-of-life?

Health Literacy and 1-Year Mortality: Mechanisms of Association in Adults Hospitalized for Cardiovascular Disease

Qualitative Exploration of Barriers to Statin Adherence and Lipid Control

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