Health literacy among patients with subarachnoid hemorrhage

Patients with subarachnoid hemorrhage (SAH) often experience cognitive deficits and require extensive and complex medical care. However, there is minimal literature investigating how SAH impacts health literacy and how this may affect care. Accordingly, we aim to leverage the NIH's All of Us Research Program to assess how SAH relates to health literacy among a large and diverse patient cohort.

Using the NIH's All of Us Research Program, respondents with SAH were matched to those without SAH via nearest-neighbor propensity score matching. Only those with SAH prior to survey completion were included. Health literacy was assessed using the Brief Health Literacy Screening Tool (BRIEF-3). Multivariable ordinal logistic regression evaluated associations, with interaction analyses by race/ethnicity and income, and responses among those with SAH were compared by race/ethnicity and income using chi-squared tests.

616 respondents with SAH were matched to 12,161 without SAH. SAH was independently associated with greater difficulty understanding health materials (OR 1.23, 95% CI 1.04-1.45; p = 0.015), increased need for assistance (OR 1.28, 95% CI 1.09-1.50; p = 0.003), and lower confidence completing medical forms (OR 0.79, 95% CI 0.67-0.93; p = 0.005). Among participants with SAH, low health literacy was more prevalent among non-Hispanic Black (36.0%) and Hispanic (21.7%) individuals compared to non-Hispanic White individuals (8.0%), and among those with lower income (all p < 0.001).

SAH is associated with worse health literacy, with persistent socioeconomic disparities. Targeted strategies regarding health literacy may improve care for this vulnerable population.