Baseline Characteristics, overall and stratified by income status.

<p>*CV = 16.5–33 (Interpret with caution); Abbreviations: CI – confidence interval; PRR – prevalence rate ratio; sep/div – separated or divorced; SK – Saskatchewan; MB – Manitoba; BC – British Columbia.</p

Noting “personal choice” as reason for non-adherence to health behavior change or non-receipt of monitoring tests: Low income vs. High income.

<p>Noting “personal choice” as reason for non-adherence to health behavior change or non-receipt of monitoring tests: Low income vs. High income.</p

The Association of Income with Health Behavior Change and Disease Monitoring among Patients with Chronic Disease

<div><p>Background</p><p>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.</p><p>Methods</p><p>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.</p><p>Results</p><p>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.</p><p>Conclusions</p><p>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.</p></div

Noting non-personal choice reasons for non-adherence to health behavior change or non-receipt of monitoring tests: Low income vs. High income.

<p>Noting non-personal choice reasons for non-adherence to health behavior change or non-receipt of monitoring tests: Low income vs. High income.</p

Formation of study cohort and criteria for exclusion.

<p>Abbreviations: eGFR, estimated glomerular filtration rate; S_Cr, serum creatinine; TST90, total sleep time spent with oxygen saturation <90%.</p

Association between nocturnal hypoxia and risk of accelerated loss of kidney function^*.

<p>Abbreviations: OR, odds ratio; CI, confidence interval.</p><p>*Reference group is subjects without nocturnal hypoxia.</p>†<p>Adjusted for age, body mass index, diabetes and heart failure.</p>‡<p>Adjusted for respiratory disturbance index (RDI), age, body mass index, diabetes and heart failure.</p

Proportion of population who received recommendations for health behavior change, overall and by income status.

<p>Abbreviations: CI – confidence interval; PRR – prevalence rate ratio.</p

Baseline subject characteristics, overall and by presence of nocturnal hypoxia^*.

<p>Abbreviations: eGFR, estimated glomerular filtration rate; RDI, respiratory disturbance index; BMI, body mass index; COPD, chronic obstructive pulmonary disease; ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker.</p><p>Cardiovascular Medications include acetylsalicylic acid, nitrates, calcium channel blockers, beta blockers, arrhythmia medications, and lipid lower medications.</p><p>*Results presented as mean (standard deviation) unless otherwise indicated.</p>†<p>p-value for categorical variables based on a chi-square test of independence; p-value for continuous variables based on a 2-sample t-test for a difference, assuming equal variances.</p>‡<p>Neck Circumference: n = 683 (Overall), n = 381 (Nocturnal Hypoxia absent), n = 302 (Nocturnal Hypoxia present).</p