Intervention can overcome socioeconomic disparities

September 1, 2002

Pharmaceutical Representative

Socioeconomic disparities in health can be reduced, and possibly eliminated in some cases, by specific interventions that help patients better manage their own treatment, according to a new study by researchers at RAND, a Santa Monica, CA-based policy research firm.

Socioeconomic disparities in health can be reduced, and possibly eliminated in some cases, by specific interventions that help patients better manage their own treatment, according to a new study by researchers at RAND, a Santa Monica, CA-based policy research firm. The study, which showed an association between patients' level of education and adherence to complex treatment regimens for two diseases - HIV and diabetes - found that income, age, race and gender were not as important as education in influencing health, but that differences associated with education could be effectively overcome.

"Lower socioeconomic status - less education and lower income and wealth - has for some time been strongly linked with poorer health," said James P. Smith, who conducted the research with colleague Dana P. Goldman. "This research offers a new and practical explanation for why these differences in health may occur and how we might address them."

Education plays a big role

For both diseases studied, there were large differences in adherence to treatment regimens depending on education, and differences in compliance with treatment significantly affected overall health status. The highly active antiretroviral therapy data on HIV showed, for example, that 57% of college graduates always stuck with their treatment plan, while only 37% of high school dropouts did so. Income did not appear to affect adherence to treatment, while education consistently mattered. Further analysis demonstrated that complete adherence to treatment was the single most important factor in improving health outcomes and that the role of education made a difference only in affecting adherence.

The study of people with diabetes went a step further, comparing patient behaviors in the Diabetes Control and Complications Trial. When the researchers compared conventional therapies with a more intensive therapeutic approach, they found that education no longer had an effect on outcome. There was little variance in health status among people in different educational groups using the more intensive, enforced treatment, suggesting that imposing strict adherence to a treatment regimen helped the less-educated more than those with higher education.

"These analyses show that the ability to adhere to a treatment regimen, while it can be influenced by education, is the bottom line for better health," said Goldman. "Our study suggests to health providers that not all patients are alike in their ability to adhere to and maintain complicated medical regimens. But we also demonstrate that [socioeconomic status] effects are amenable to change with training, monitoring and possibly other approaches." PR

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