Health literacy and mortality among elderly persons

Area of Science:

• Public Health
• Health Literacy Research
• Gerontology

Background:

• Low health literacy is linked to poorer health outcomes, including reduced health knowledge and self-management.
• Existing cross-sectional studies suggest associations between low health literacy and adverse health status.
• The independent predictive value of health literacy for mortality remained to be determined.

Purpose of the Study:

• To investigate whether low health literacy levels independently predict overall mortality.
• To determine if low health literacy predicts cause-specific mortality, including cardiovascular and cancer deaths.
• To compare the predictive power of health literacy versus educational attainment on mortality risk.

Main Methods:

• Prospective cohort study of 3260 Medicare managed-care enrollees across 4 US metropolitan areas.
• Data collected on demographics, chronic conditions, health status, behaviors, and functional health literacy.
• Mortality outcomes (all-cause, cardiovascular, cancer) tracked via the National Death Index through 2003.

Main Results:

• Crude mortality rates increased significantly with decreasing health literacy levels (18.9% adequate, 28.7% marginal, 39.4% inadequate).
• After adjustment for covariates, inadequate health literacy (HR 1.52) and marginal health literacy (HR 1.13) were associated with increased all-cause mortality.
• Inadequate health literacy was linked to higher risk-adjusted cardiovascular death rates, but not cancer-related deaths. Education level showed weak association with mortality.

Conclusions:

• Inadequate health literacy, assessed by reading fluency, is an independent predictor of all-cause mortality in older adults.
• Health literacy independently predicts cardiovascular death risk among community-dwelling elderly individuals.
• Reading fluency emerges as a stronger predictor of mortality than years of education in assessing socioeconomic disparities in health.