Health literacy and mortality among elderly persons
Health literacy and mortality among elderly persons
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DOI：
10.1001/archinte.167.14.1503
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发表时间：
2007-07-23
影响因子：
--
通讯作者：
Huang, Jenny
中科院分区：
文献类型：
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作者：
Baker, David W.;Wolf, Michael S.;Huang, Jenny
背景资料：健康素养水平低的个体健康知识较少，慢性病自我管理较差，预防服务利用率较低，横断面研究中健康状况较差。我们试图确定是否低健康素养水平独立预测整体和原因特异性mortality.Methods：我们设计了一个前瞻性队列研究的3260医疗保险管理的医疗注册在4个美国大都市地区谁在1997年接受采访，以确定他们的人口特征，慢性疾病，自我报告的身体和心理健康，健康行为。参与者还完成了成人功能性健康素养测试的简化版本。主要结果指标包括全因和病因特异性（心血管、癌症和其他）死亡率，使用2003年国家死亡指数的数据。有足够医疗保险的参与者的粗死亡率健康素养水平较低（n = 2094）、较低（n = 366）和不足（n = 800）的比例分别为18.9%、28.7%和39.4%（P <00 1）。在调整人口统计学、社会经济状况和基线健康状况后，与健康素养充足的参与者相比，健康素养不足和边缘参与者的全因死亡率风险比分别为1.52（95%置信区间，1.26-1.83）和1.13（95%置信区间，0.90-1.41）。相比之下，在双变量分析中，完成学业的年限与死亡率只有微弱的相关性，在多变量模型中也没有显著性。健康素养不足的参与者有较高的风险调整后的心血管疾病死亡率，但没有死亡由于cancer.Conclusions：健康素养不足，阅读流畅性，独立预测全因死亡率和心血管疾病死亡社区居住的老年人。阅读流畅度是一个比教育更强大的变量，用于检查社会经济地位和健康之间的联系。
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.