The association of income with health behavior change and disease monitoring among patients with chronic disease

David J T Campbell; Paul E Ronksley; Braden J Manns; Marcello Tonelli; Claudia Sanmartin; Robert G Weaver; Deirdre Hennessy; Kathryn King-Shier; Tavis Campbell; Brenda R Hemmelgarn; Interdisciplinary Chronic Disease Collaboration

doi:10.1371/journal.pone.0094007

The association of income with health behavior change and disease monitoring among patients with chronic disease

PLoS One. 2014 Apr 10;9(4):e94007. doi: 10.1371/journal.pone.0094007. eCollection 2014.

Affiliations

¹ Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
² Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Statistics Canada, Health Analysis Division, Ottawa, Ontario, Canada.
³ Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Institute of Public Health, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
⁴ Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
⁵ Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Statistics Canada, Health Analysis Division, Ottawa, Ontario, Canada.
⁶ Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁷ Statistics Canada, Health Analysis Division, Ottawa, Ontario, Canada.
⁸ Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Institute of Public Health, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada; Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.
⁹ Department of Psychology, University of Calgary, Calgary, Alberta, Canada.

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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Canada / epidemiology
Cardiovascular Diseases / epidemiology
Choice Behavior
Cholesterol / blood
Chronic Disease
Female
Health Behavior*
Health Care Costs
Health Promotion / methods
Health Services Accessibility
Humans
Male
Middle Aged
Patient Compliance*
Poverty*
Prevalence
Regression Analysis
Surveys and Questionnaires

Substances

Cholesterol

Grants and funding

This project was supported by a Team Grant from Alberta Innovates Health Solutions. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors can declare that their provision of funding does not alter their adherence to all the PLOS ONE policies on data sharing and materials.