Impact of Family Socioeconomic Status on Health‐Related Quality of Life in Children With Critical Congenital Heart Disease

Abstract

Background Socioeconomic status ( SES ) is associated with health‐related quality of life ( HRQOL ) for children with critical congenital heart disease; however, literature from newly industrialized countries is scarce. Methods and Results This cross‐sectional study included 2037 surviving patients operated on for critical congenital heart disease at a tertiary hospital in China between May 2012 and December 2015. All eligible patients were aged 2 to 12 years. HRQOL was measured by the Pediatric Quality of Life Inventory 4.0 generic and 3.0 cardiac modules. Family SES was assessed by a composite of household income in the past year and occupation and education level of each parent in the family. Mean scores of major domains in HRQOL were significantly lower in the low‐ SES group than in the medium‐ and high‐ SES groups (total generic scores: 71.2±7.9 versus 75.0±8.0 and 76.0±7.9, respectively [ P <0.001]; psychosocial functioning: 70.8±9.0 versus 74.4±8.4 and 75.3±8.4 [ P <0.001]; physical functioning: 71.6±10.4 versus 76.0±9.7 and 77.1±9.4 [ P <0.001]; heart symptoms: 71.9±11.6 versus 75.7±11.0 and 76.8±10.3 [ P <0.001]; cognitive problems: 65.4±11.1 versus 69.4±12.1 and 74.6±13.6 [ P <0.001]). After adjustment for other clinical and demographic variables in the multivariable linear regression model, family SES significantly affected all dimensions of HRQOL except for treatment barriers, treatment anxiety, physical appearance and communication. Conclusions Family SES is an important factor associated with HRQOL in patients with critical congenital heart disease. Further targeted interventions to improve HRQOL that consider the family and environmental issues confronted by those who are economically disadvantaged might help these patients have better outcomes.

Exploring Risk and Resilient Profiles for Functional Impairment and Baseline Predictors in a 2-Year Follow-Up First-Episode Psychosis Cohort Using Latent Class Growth Analysis

“…These families may likewise have more resources to identify the first psychotic symptoms and enable an earlier engagement with mental health services [ 73 ]. It could also translate more family support or means to provide better care in the post-FEP period [ 74 ]. In any case, our results emphasize the need for social interventions to promote and educate on mental health and facilitate the access to mental health services in the pre- and post-FEP period [ 75 , 76 ], as it has been done in Australia through the headspace initiative ( ).…”

Poverty, quality of life and psychological wellbeing in adults with congenital heart disease in Chile

“…Aiming at assessing this factor, Jackson et al surveyed individual income of CHD patients and showed that earning less than US$30,000 per year explained 23% of the variability in the QoL [12]. A recent study in Chinese children suffering from CHD showed that there is an association between QoL and socioeconomic status [40], assessed by means of household income, parental occupation and educational level. Nevertheless, the mechanism by which socioeconomic level influences QoL is still not fully characterized.…”

“…It has been suggested that CHD causes poverty or that inability to pay makes access to healthcare more problematic [12], which is not the case for Chilean patients. Other plausible explanations are an eventual link between poverty and low health literacy, affecting patients' adherence and healthcare consulting behavior [40], and the effect of long-term and comprehensive rehabilitation therapy, which is often expensive. The association between socioeconomic status and these patients' QoL should be carefully explored, as well as the underlying mechanisms.…”

Emotional quality-of-life and patient-reported limitation in sports participation in children with uncorrected congenital and acquired heart disease in healthcare-restricted settings in low- and middle-income countries

“…This said, our mean emotional functioning scores were similar to those of patients with corrected defects in Pakistan, 18 higher than those of palliated single ventricle patients in two high-income countries, 15,16 and lower than those of healthy control groups in both low-middle 4 and high-income countries. 12,14,16,17 Established predictors of poorer emotional quality-of-life in patients with corrected or palliated defects or those with mild lesions that did not require corrective surgery include: low family income, 12,17,[19][20][21][22] short duration of parental education, 23 single parent status, 24 ethnic minority status, 25 absence of spirituality, 25 at least one regular symptom, 19,26 subjective exercise limitation, 27 NYHA class, 23 ROSS Class, 28 objective exercise capacity, 19,29 specific lesion types, 13,18,[30][31][32] lesion complexity, 12,13,16,[33][34][35][36][37] previous surgeries, 38 number of clinic appointments, 27,33 school absence, 23,39 and medication burden. 18,27,33,39...…”