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Open Access Highly Accessed Research

The impact of socio-economic status on health related quality of life for children and adolescents with heart disease

Amy Cassedy12*, Dennis Drotar3, Richard Ittenbach1, Shawna Hottinger4, Jo Wray5, Gil Wernovsky67, Jane W Newburger89, Lynn Mahony10, Kathleen Mussatto11, Mitchell I Cohen12 and Bradley S Marino13

Author Affiliations

1 Department of Pediatrics, Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA

2 Department of Sociology, McMicken College of Arts and Sciences, University of Cincinnati, Cincinnati, USA

3 Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA

4 Department of Pediatrics, Divisions of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA

5 Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK

6 Department of Anesthesiology and Critical Care, Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

7 Division of Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

8 Department of Cardiology, Children's Hospital Boston, Boston, MA, USA

9 Department of Pediatrics, Harvard Medical School, Boston, MA, USA

10 Department of Pediatrics, Division of Cardiology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA

11 Department of Pediatrics, Division of Cardiology, Children‘s Hospital of Wisconsin, Milwaukee, WI, USA

12 Department of Pediatrics, Division of Cardiology, Phoenix Children‘s Hospital, Phoenix, AZ, USA

13 Department of Pediatrics, Divisions of Cardiology and Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA

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Health and Quality of Life Outcomes 2013, 11:99  doi:10.1186/1477-7525-11-99

Published: 18 June 2013

Abstract

Background

Socioeconomic status (SES) is known to influence children’s health-related quality of life. Many SES indicators assess distinct dimensions of a family’s position rather than measuring the same underlying construct. Many researchers, however, see SES indicators as interchangeable. The primary aim of this study was to determine which measure of SES had the strongest impact on health-related quality of life.

Methods

This is a secondary analysis of the Pediatric Cardiac Quality of Life Inventory Validation Study. The SES variables were family income, Hollingshead Index (occupational prestige), and highest parent educational attainment level. Health-related quality of life was measured using the Pediatric Cardiac Quality of Life Inventory. Correlations tested the relationship among the three SES indicators. Regression-based modeling was used to calculate the strength of the association between SES measures and the Pediatric Cardiac Quality of Life Inventory.

Results

The correlations among the SES measures were moderately high, with the correlation between the Hollingshead Index and parental education being r = 0.62 (95% CI = 0.56-0.65). There were equally high correlations between family income and the Hollingshead (r = 0.61, 95% CI = 0.57-0.65) and a slightly lower correlation between family income and parental education (r = 0.55, 95% CI = 0.52-0.59). Family income had the highest explanatory value compared to the Hollingshead Index or parental educational attainment, while controlling for sex, race, current cardiac status, and original diagnosis, accounting for 4-5% of the variation in patient and parent Pediatric Cardiac Quality of Life Inventory Total score, respectively, compared to the other SES measures.

Conclusion

Family income as an SES measure demonstrated the greatest fidelity with respect to health-related quality of life as measured by the Pediatric Cardiac Quality of Life Inventory across respondent groups and explained more of the variation compared to the Hollingshead Index or highest parental educational attainment.