Osborn Chandra Y, Kripalani Sunil, Goggins Kathryn M, Wallston Kenneth A
J Health Care Poor Underserved. 2017;28(1):499-513. doi: 10.1353/hpu.2017.0036.
Non-traditional indicators of socioeconomic status (SES; e.g., home ownership) may be just as or even more predictive of health outcomes as traditional indicators of SES (e.g., income). This study tested whether financial strain (i.e., difficulty paying monthly bills) predicted medication non-adherence and worse self-rated health. Research assistants administered surveys to 1,527 patients with acute coronary syndromes or acute decom-pensated heart failure. In adjusted models, having a higher income was associated with being more adherent (p < .001), but was non-significant when adjusted for financial strain. Education, income, less financial strain, and being employed were each associated with better self-rated health (p < .001). Financial strain was associated with less adherence (β =-.17, p < .001) and worse self-rated health (β = -.23, p < .001), and mediated the effect of income on adherence (coeff = .078 [BCa 95% CI: .051 to .108]). Future research should further explore the nuanced link between SES and health behaviors and outcomes.
社会经济地位（SES）的非传统指标（例如，房屋所有权）可能与SES的传统指标（例如，收入）一样，甚至更能预测健康结果。本研究测试了经济压力（即每月支付账单困难）是否能预测药物治疗依从性差和自我健康评价较差。研究助理对1527例急性冠状动脉综合征或急性失代偿性心力衰竭患者进行了调查。在调整模型中，较高的收入与更高的依从性相关（p <.001），但在调整经济压力后无统计学意义。教育程度、收入、较少的经济压力和就业均与更好的自我健康评价相关（p <.001）。经济压力与较低的依从性（β = -0.17，p <.001）和较差的自我健康评价（β = -0.23，p <.001）相关，并介导了收入对依从性的影响（系数 = 0.078 [BCa 95% CI：0.051至0.108]）。未来的研究应进一步探索SES与健康行为及结果之间的细微联系。
