Abstract 9690: Perceived Control, but Not Health Literacy or Self-Care Link Income Inequity and Health-Related Quality of Life in Patients With Heart Failure

Abstract

Background: Income, one of the social determinants of health, has a major impact on health outcomes, especially health-related quality of life (HRQOL) in patients with heart failure (HF). Yet, the mechanisms for the association between income inequity and HRQOL are not clear. Objective: To explore the effect of income inequity on HRQOL, as well as factors that mediate this relationship in patients with HF. Method: We included 540 patients with HF (age 65±13, female 41%, NYHA class III/IV 35%) in this study. Household income was collected by patient interview. HRQOL was measured using the Minnesota Living with Heart Failure. We collected demographic (age, ethnicity, education, marital status), clinical (NYHA, LVEF, ACE inhibitor use, beta-blocker use), and cognitive/behavioral data (health literacy, self-care behaviors, perceived control) as potential factors that might link income inequity and HRQOL. Chi-square, t-tests, and linear regression were used for data analyses. Results: About three quarters (74%) of patients had low household income (≤ $40K). Patients in the low household income group were more likely to be female, minority, not married, and to have less than a high school education, low health literacy, and lower levels of perceived control than those in the high household income group. There were no difference in age, LVEF, ACE inhibitor use, beta-blocker use, or self-care behaviors between low and high income groups. Income was associated with HRQOL. Patients in the low income group had poorer HRQOL. With and without adjustment for all covariates (age, gender, ethnicity, education, marital status, left ventricular ejection fraction, Angiotensin Converting Enzyme inhibitor use, beta-blocker use), income was not a significant predictor of HRQOL ( p = .29) after entering perceived control ( p < .001) in the model, demonstrating mediation. Health literacy and self-care behaviors did not mediate the relationship between income and HRQOL. Conclusion: HF patients with low household income were more likely to have poorer HRQOL. Perceived control was a mediator between income inequity and HRQOL. This suggests intervention to enhance patients’ perceived control may reduce the impact of income inequity on HRQOL.