Can patient self-management help explain the SES health gradient?

TitleCan patient self-management help explain the SES health gradient?
Publication TypeJournal Article
Year of Publication2002
AuthorsGoldman, DP, Smith, JP
JournalProc Natl Acad Sci U S A
Date Published2002 Aug 06
ISSN Number0027-8424
Call Numberpubs_2002_Goldman-Smith.pdf
KeywordsAdolescent, Adult, Antiretroviral Therapy, Highly Active, Diabetes Mellitus, Type 1, Educational Status, Female, Health Knowledge, Attitudes, Practice, HIV Infections, Humans, Insulin, Longitudinal Studies, Male, Patient Compliance, Population Surveillance, Prospective Studies, Randomized Controlled Trials as Topic, Self Care, Social Class

There are large differences in health outcomes by socioeconomic status (SES) that cannot be explained fully by traditional arguments, such as access to care or poor health behaviors. We consider a different explanation-better self-management of disease by the more educated. We examine differences by education in treatment adherence among patients with two illnesses, diabetes and HIV, and then assess the subsequent impact of differential adherence on health status. One unique component of this research is that for diabetes we combine two different surveys-one cohort study and one randomized clinical trial-that are usually used exclusively by either biomedical or/and social scientists separately. For both illnesses, we find significant effects of adherence that are much stronger among patients with high SES. After controlling for other factors, more educated HIV+ patients are more likely to adhere to therapy, and this adherence made them experience improvements in their self-reported general health. Similarly, among diabetics, the less educated were much more likely to switch treatment, which led to worsening general health. In the randomized trial setting, intensive treatment regimens that compensated for poor adherence led to better improvements in glycemic control for the less educated. Among two distinct chronic illnesses, the ability to maintain a better health regimen is an important independent determinant of subsequent health outcomes. This finding is robust across clinical trial and population-based settings. Because this ability varies by schooling, self-maintenance is an important reason for the steep SES gradient in health outcomes.

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Alternate JournalProc Natl Acad Sci U S A
Citation Key6814
PubMed ID12140364
PubMed Central IDPMC125075
Grant ListR01 AG023363 / AG / NIA NIH HHS / United States