The association of income with health behavior change and disease monitoring among patients with chronic disease.
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.
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
David J T
DJ
Campbell
Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Statistics Canada, Health Analysis Division, Ottawa, Ontario, Canada.
Paul E
PE
Ronksley
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.
Braden J
BJ
Manns
Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Marcello
M
Tonelli
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Statistics Canada, Health Analysis Division, Ottawa, Ontario, Canada.
Claudia
C
Sanmartin
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Robert G
RG
Weaver
Statistics Canada, Health Analysis Division, Ottawa, Ontario, Canada.
Deirdre
D
Hennessy
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.
Kathryn
K
King-Shier
Department of Psychology, University of Calgary, Calgary, Alberta, Canada.
Tavis
T
Campbell
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.
Brenda R
BR
Hemmelgarn
D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002755:Choice Behavior; D002784:Cholesterol / Q000097:blood; D002908:Chronic Disease; D005260:Female; D015438:Health Behavior; D017048:Health Care Costs; D006293:Health Promotion / Q000379:methods; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011203:Poverty; D015995:Prevalence; D012044:Regression Analysis; D011795:Surveys and Questionnaires
D002784:Cholesterol