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Is lower socio-economic status associated with more impaired health care access and poorer quality of life in patients with COPD? : what is the role of psychosocial factors in this relationship?

Background: Socioeconomic deprivation is a determinant of health care access and quality of life in many diseases. The current study explored this effect in Chronic Obstructive Pulmonary Disease (COPD) and examined the role of psychosocial variables in this relationship. Aims: The primary aim of this thesis was to establish whether lower socio-economic status (SES) was associated with decreased health care access (HCA) and poorer quality of life (QoL) in patients with COPD. The secondary aim examined whether psychosocial factors mediated the relationship between socio-economic status, health care access and quality of life. Methods: Cross-sectional, interview-based survey in London involving COPD patients > 40 years recruited in primary care. Measures included socio-economic status, illness perceptions, health care access, quality of life, Medical Research Council (MRC) dyspnoea scale, general self-efficacy scale, social capital, Hospital Anxiety and Depression Scale (HADS), and spirometry. Results: COPD confirmed by spirometry in 176 (85%) participants. 38.6% female, mean age 69 years, distribution of disease severity (GOLD): Grades 1-4 (mild – very severe) = 15%; 51%; 30%; 5%. Lower SES was not associated with more impaired HCA. Lower SES in terms of income level was associated with poorer QoL. The relationship between SES and HCA was not mediated by any of the psychosocial variables but the relationship between SES in terms of income level and QoL was. Conclusion: More deprived COPD patients were as likely to get equal HCA as their more affluent counterparts. More deprived COPD patients in terms of income level were more likely to report poorer QoL. Illness perceptions were significantly associated with HCA and QoL. Findings emphasized the role of SES measures and illness perceptions in this patient group and the variability of their effect on different outcomes. Future research involving longitudinal design could increase understanding of these associations in different life and disease stages.
Date January 2014
CreatorsGeorgopoulou, Sofia
PublisherKing's College London (University of London)
Source SetsEthos UK
Detected LanguageEnglish
TypeElectronic Thesis or Dissertation

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