 |
|
Health Literacy and Mortality Among Elderly Persons
David W. Baker, MD, MPH;
Michael S. Wolf, PhD, MPH;
Joseph Feinglass, PhD;
Jason A. Thompson, BA;
Julie A. Gazmararian, PhD;
Jenny Huang, PhD
Arch Intern Med. 2007;167(14):1503-1509.
Background Individuals with low levels of health literacy have less health knowledge, worse self-management of chronic disease, lower use of preventive services, and worse health in cross-sectional studies. We sought to determine whether low health literacy levels independently predict overall and cause-specific mortality.
Methods We designed a prospective cohort study of 3260 Medicare managed-care enrollees in 4 US metropolitan areas who were interviewed in 1997 to determine their demographic characteristics, chronic conditions, self-reported physical and mental health, and health behaviors. Participants also completed the shortened version of the Test of Functional Health Literacy in Adults. Main outcome measures included all-cause and cause-specific (cardiovascular, cancer, and other) mortality using data from the National Death Index through 2003.
Results The crude mortality rates for participants with adequate (n = 2094), marginal (n = 366), and inadequate (n = 800) health literacy were 18.9%, 28.7%, and 39.4%, respectively (P < .001). After adjusting for demographics, socioeconomic status, and baseline health, the hazard ratios for all-cause mortality were 1.52 (95% confidence interval, 1.26-1.83) and 1.13 (95% confidence interval, 0.90-1.41) for participants with inadequate and marginal health literacy, respectively, compared with participants with adequate health literacy. In contrast, years of school completed was only weakly associated with mortality in bivariate analyses and was not significant in multivariate models. Participants with inadequate health literacy had higher risk-adjusted rates of cardiovascular death but not of death due to cancer.
Conclusions Inadequate health literacy, as measured by reading fluency, independently predicts all-cause mortality and cardiovascular death among community-dwelling elderly persons. Reading fluency is a more powerful variable than education for examining the association between socioeconomic status and health.
Author Affiliations: Division of General Internal Medicine (Drs Baker, Wolf, and Feinglass and Mr Thompson), Institute for Healthcare Studies (Drs Baker, Wolf, and Feinglass), and Department of Preventive Medicine (Dr Huang), Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and Rollins School of Public Health, Emory University, Atlanta, Georgia (Dr Gazmararian).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Literacy and Learning in Health Care
Wolf et al.
Pediatrics 2009;124:S275-S281.
ABSTRACT
| FULL TEXT
The Health Literacy of Parents in the United States: A Nationally Representative Study
Yin et al.
Pediatrics 2009;124:S289-S298.
ABSTRACT
| FULL TEXT
Health Literacy and Quality: Focus on Chronic Illness Care and Patient Safety
Rothman et al.
Pediatrics 2009;124:S315-S326.
ABSTRACT
| FULL TEXT
Health literacy revisited: what do we mean and why does it matter?
Peerson and Saunders
HEALTH PROMOT INT 2009;24:285-296.
ABSTRACT
| FULL TEXT
Diabetes Numeracy: An overlooked factor in understanding racial disparities in glycemic control
Osborn et al.
Diabetes Care 2009;32:1614-1619.
ABSTRACT
| FULL TEXT
The Contribution of Health Literacy to Disparities in Self-Rated Health Status and Preventive Health Behaviors in Older Adults
Bennett et al.
Ann Fam Med 2009;7:204-211.
ABSTRACT
| FULL TEXT
Literacy and Informed Consent: A Case for Literacy Screening in Glaucoma Research
Muir and Lee
Arch Ophthalmol 2009;127:698-699.
FULL TEXT
Heeding Our Words: Complexities of Research Among Low-Literacy Populations
Simon et al.
JCO 2009;27:1938-1940.
FULL TEXT
Health Literacy: Communication Strategies to Improve Patient Comprehension of Cardiovascular Health
Oates and Paasche-Orlow
Circulation 2009;119:1049-1051.
FULL TEXT
An Investigation of the Relationship Between Health Literacy and Social Communication Skills in Older Adults
Hester
Communication Disorders Quarterly 2009;30:112-119.
ABSTRACT
So Much to Do, So Little Time: Care for the Socially Disadvantaged and the 15-Minute Visit
Fiscella and Epstein
Arch Intern Med 2008;168:1843-1852.
ABSTRACT
| FULL TEXT
A Steep Increase in Domestic Fatal Medication Errors With Use of Alcohol and/or Street Drugs
Phillips et al.
Arch Intern Med 2008;168:1561-1566.
ABSTRACT
| FULL TEXT
Neighborhood Income and Individual Education: Effect on Survival After Myocardial Infarction
Gerber et al.
Mayo Clin Proc. 2008;83:663-669.
ABSTRACT
| FULL TEXT
Differential survival with Alzheimer disease
Fillenbaum
Neurology 2008;70:1158-1160.
FULL TEXT
The Medical Tongue: U.S. Laws And Policies On Language Access
Youdelman
Health Aff (Millwood) 2008;27:424-433.
ABSTRACT
| FULL TEXT
|
