Impact of health literacy on socioeconomic and racial differences in health in an elderly population

J Gen Intern Med. 2006 Aug;21(8):857-61. doi: 10.1111/j.1525-1497.2006.00530.x.

Abstract

Background: Differences in health literacy levels by race and education are widely hypothesized to contribute to health disparities, but there is little direct evidence.

Objective: To examine the extent to which low health literacy exacerbates differences between racial and socioeconomic groups in terms of health status and receipt of vaccinations.

Design: Retrospective cohort study. PARTICIPANTS (OR PATIENTS OR SUBJECTS): Three thousand two hundred and sixty noninstitutionalized elderly persons enrolling in a Medicare managed care plan in 1997 in Cleveland, OH; Houston, TX; South Florida; and Tampa, FL.

Measurements: Dependent variables were physical health SF-12 score, mental health SF-12 score, self-reported health status, receipt of influenza vaccine, and receipt of pneumococcal vaccine. Independent variables included health literacy, educational attainment, race, income, age, sex, chronic health conditions, and smoking status.

Results: After adjusting for demographic and health-related variables, individuals without a high school education had worse physical and mental health and worse self-reported health status than those with a high school degree. Accounting for health literacy reduced these differences by 22% to 41%. Black individuals had worse self-reported health status and lower influenza and pneumococcal vaccination rates. Accounting for health literacy reduced the observed difference in self-reported health by 25% but did not affect differences in vaccination rates.

Conclusions: We found that health literacy explained a small to moderate fraction of the differences in health status and, to a lesser degree, receipt of vaccinations that would normally be attributed to educational attainment and/or race if literacy was not considered.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • African Continental Ancestry Group*
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Educational Status
  • European Continental Ancestry Group*
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Health Status*
  • Humans
  • Male
  • Retrospective Studies
  • Socioeconomic Factors