Paasche-Orlow Michael K, Parker Ruth M, Gazmararian Julie A, Nielsen-Bohlman Lynn T, Rudd Rima R
Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA.
J Gen Intern Med. 2005 Feb;20(2):175-84. doi: 10.1111/j.1525-1497.2005.40245.x.
To systematically review U.S. studies examining the prevalence of limited health literacy and to synthesize these findings by evaluating demographic associations in pooled analyses.
We searched the literature for the period 1963 through January 2004 and identified 2,132 references related to a set of specified search terms. Of the 134 articles and published abstracts retrieved, 85 met inclusion criteria, which were 1) conducted in the United States with > or =25 adults, 2) addressed a hypothesis related to health care, 3) identified a measurement instrument, and 4) presented primary data. The authors extracted data to compare studies by population, methods, and results.
The 85 studies reviewed include data on 31,129 subjects, and report a prevalence of low health literacy between 0% and 68%. Pooled analyses of these data reveal that the weighted prevalence of low health literacy was 26% (95% confidence interval [CI], 22% to 29%) and of marginal health literacy was 20% (95% CI, 16% to 23%). Most studies used either the Rapid Estimate of Adult Literacy in Medicine (REALM) or versions of the Test of Functional Health Literacy in Adults (TOFHLA). The prevalence of low health literacy was not associated with gender (P=.38) or measurement instrument (P=.23) but was associated with level of education (P=.02), ethnicity (P=.0003), and age (P=.004).
A pooled analysis of published reports on health literacy cannot provide a nationally representative prevalence estimate. This systematic review exhibits that limited health literacy, as depicted in the medical literature, is prevalent and is consistently associated with education, ethnicity, and age. It is essential to simplify health services and improve health education. Such changes have the potential to improve the health of Americans and address the health disparities that exist today.
系统回顾美国关于有限健康素养患病率的研究，并通过在汇总分析中评估人口统计学关联来综合这些研究结果。
我们检索了1963年至2004年1月期间的文献，确定了与一组特定检索词相关的2132篇参考文献。在检索到的134篇文章和已发表摘要中，85篇符合纳入标准，这些标准为：1）在美国进行，研究对象为25名及以上成年人；2）涉及与医疗保健相关的假设；3）确定了测量工具；4）呈现了原始数据。作者提取数据以按人群、方法和结果对研究进行比较。
所回顾的85项研究纳入了31129名受试者的数据，报告的低健康素养患病率在0%至68%之间。对这些数据的汇总分析显示，低健康素养的加权患病率为26%（95%置信区间[CI]，22%至29%），边缘健康素养的加权患病率为20%（95%CI，16%至23%）。大多数研究使用了《医学成人识字率快速评估》（REALM）或《成人功能性健康素养测试》（TOFHLA）的版本。低健康素养的患病率与性别（P = 0.38）或测量工具（P = 0.23）无关，但与教育水平（P = 0.02）、种族（P = 0.0003）和年龄（P = 0.004）有关。
对已发表的健康素养报告进行汇总分析无法提供具有全国代表性的患病率估计值。这项系统评价表明，医学文献中所描述的有限健康素养很普遍，并且始终与教育、种族和年龄相关。简化医疗服务和改善健康教育至关重要。这些改变有可能改善美国人的健康状况，并解决当今存在的健康差异问题。
