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. 2020 Apr 28;20(1):565.
doi: 10.1186/s12889-020-08498-8.

Associations of Health Literacy With Socioeconomic Position, Health Risk Behavior, and Health Status: A Large National Population-Based Survey Among Danish Adults

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Free PMC article

Associations of Health Literacy With Socioeconomic Position, Health Risk Behavior, and Health Status: A Large National Population-Based Survey Among Danish Adults

Majbritt Tang Svendsen et al. BMC Public Health. .
Free PMC article

Abstract

Background: Health literacy concerns the ability of citizens to meet the complex demands of health in modern society. Data on the distribution of health literacy in general populations and how health literacy impacts health behavior and general health remains scarce. The present study aims to investigate the prevalence of health literacy levels and associations of health literacy with socioeconomic position, health risk behavior, and health status at a population level.

Methods: A nationwide cross-sectional survey linked to administrative registry data was applied to a randomly selected sample of 15,728 Danish individuals aged ≥25 years. By the short form HLS-EU-Q16 health literacy was measured for the domains of healthcare, disease prevention, and health promotion. Adjusted multinomial logistic regression analyses were used to estimate associations of health literacy with demographic and socioeconomic characteristics, health risk behavior (physical activity, smoking, alcohol consumption, body weight), and health status (sickness benefits, self-assessed health).

Results: Overall, 9007 (57.3%) individuals responded to the survey. Nearly 4 in 10 respondents faced difficulties in accessing, understanding, appraising, and applying health information. Notably, 8.18% presented with inadequate health literacy and 30.94% with problematic health literacy. Adjusted for potential confounders, regression analyses showed that males, younger individuals, immigrants, individuals with basic education or income below the national average, and individuals receiving social benefits had substantially higher odds of inadequate health literacy. Among health behavior factors (smoking, high alcohol consumption, and inactivity), only physical behavior [sedentary: OR: 2.31 (95% CI: 1.81; 2.95)] was associated with inadequate health literacy in the adjusted models. The long-term health risk indicator body-weight showed that individuals with obesity [OR: 1.78 (95% CI: 1.39; 2.28)] had significantly higher odds of lower health literacy scores. Poor self-assessed health [OR: 4.03 (95% CI: 3.26; 5.00)] and payments of sickness absence compensation benefits [OR: 1.74 (95% CI: 1.35; 2.23)] were associated with lower health literacy scores.

Conclusions: Despite a relatively highly educated population, the prevalence of inadequate health literacy is high. Inadequate health literacy is strongly associated with a low socioeconomic position, poor health status, inactivity, and overweight, but to a lesser extent with health behavior factors such as smoking and high alcohol consumption.

Keywords: HLS-EU-Q16; Health behavior; Health inequality; Health literacy; Health literacy questionnaire; Health risk indicators; Health status; Population survey; Social position; Socioeconomic position.

Conflict of interest statement

MTS reports grants from the Helsefonden, the Health Research Foundation of the North Denmark Region, and the Maria Pedersen and Jensine Heiberg Foundation, during the conduct of the study. CTP reports grants and speaker honorarium from Bayer. HB is a member of the editorial board in the BMC Public Health journal. The other authors report no disclosures.

Figures

Fig. 1
Fig. 1
Associations of demographic and socioeconomic characteristics with health literacy. Forrest plot presenting multivariable multinomial logistic regression model describing odds ratios (OR), with corresponding 95% confidence intervals (CI), of inadequate and problematic health literacy compared to adequate health literacy. Unadjusted and model adjusted for all covariates. Statistically significant P-values (P < 0.05) are flagged with star symbols (*)
Fig. 2
Fig. 2
Associations of health risk behavior and health status with health literacy. Forrest plot presenting multivariable multinomial logistic regression model describing odds ratios (OR), with corresponding 95% confidence intervals (CI), of inadequate and problematic health literacy compared to adequate health literacy. Unadjusted and model adjusted for all covariates. Statistically significant P-values (P < 0.05) are flagged with star symbols (*)

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