Financial strain is associated with medication nonadherence and worse self-rated health among cardiovascular patients

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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Acute Coronary Syndrome / drug therapy*
  • Age Factors
  • Aged
  • Cardiovascular Agents / administration & dosage
  • Cardiovascular Agents / economics*
  • Cardiovascular Agents / therapeutic use*
  • Female
  • Health Status
  • Heart Failure / drug therapy*
  • Humans
  • Income / statistics & numerical data
  • Male
  • Medication Adherence / statistics & numerical data*
  • Middle Aged
  • Sex Factors
  • Social Class


  • Cardiovascular Agents