Influence of health empowerment on health outcomes of different socioeconomic status: evidence from Anhui, China

Health disparities across socioeconomic status (SES) remain a critical issue. Health empowerment, a promising strategy linked to improved health outcomes, remains under explored in terms of mitigating SES-related health disparities and its potential to counteract structural inequities. This study aims to evaluate how health empowerment varies across SES strata and its association with health outcomes to inform targeted health promotion strategies for mitigating health inequalities. This study conducted a cross-sectional survey in five cities in Anhui Province via purposive sampling. Data on health empowerment (health literacy, health consciousness, and healthcare trust/fairness), health outcomes (self-rated health, chronic diseases), and SES were collected. Descriptive statistics, chi-square tests, and logistic regression were used for analysis. Among the 1,364 participants, chronic disease incidence showed a clear SES gradient (24.1% in the low SES group, 15.1% in the middle SES group, and 14.0% in the high SES group), whereas health literacy levels were lower in the low SES group when both median and upper quartile thresholds were used. High health literacy (using the upper quartile as the threshold) was linked to lower chronic disease prevalence in the low- and middle-SES groups and better self-rated health across all SES strata; health awareness was positively associated with self-rated health only in the middle- and high-SES groups, while perceived trust/fairness showing an inverse association with self-rated health in the low-SES group. Logistic regression confirmed that health literacy using the upper quartile as the threshold was associated with lower odds of chronic diseases in the low SES group (OR = 0.453, P < 0.05), with both thresholds benefiting self-rated health across all SES groups. This study confirms significant socioeconomic disparities in chronic disease incidence and health literacy, with higher health literacy levels showing a protective association against chronic diseases, particularly in the low-SES population. While health literacy is consistently associate with self-rated health across all socioeconomic strata, health awareness is associated with self-rated health only in middle- and high-SES groups, suggesting that structural barriers impede health behavior translation in vulnerable populations. The findings underscore the need for tiered health empowerment interventions targeting specific socioeconomic groups, with higher thresholds of health literacy potentially related to overcoming structural disadvantages in low-SES communities.