Baker David W, Wolf Michael S, Feinglass Joseph, Thompson Jason A, Gazmararian Julie A, Huang Jenny
Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, 676 N St Clair St, Suite 200, Chicago, IL 60611-2927, USA.
Arch Intern Med. 2007 Jul 23;167(14):1503-9. doi: 10.1001/archinte.167.14.1503.
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.
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.
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.
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.
在横断面研究中，健康素养水平较低的个体健康知识较少，慢性病自我管理较差，预防性服务利用率较低，健康状况也较差。我们试图确定低健康素养水平是否能独立预测全因死亡率和特定病因死亡率。
我们设计了一项前瞻性队列研究，对美国4个大都市地区的3260名医疗保险管理式医疗参保者进行了研究，这些参保者于1997年接受了访谈，以确定他们的人口统计学特征、慢性病状况、自我报告的身心健康状况和健康行为。参与者还完成了成人功能性健康素养测试的简版。主要结局指标包括使用截至2003年的国家死亡指数数据得出的全因死亡率和特定病因（心血管疾病、癌症和其他）死亡率。
健康素养充足（n = 2094）、边缘（n = 366）和不足（n = 800）的参与者的粗死亡率分别为18.9%、28.7%和39.4%（P <.001）。在调整了人口统计学、社会经济地位和基线健康状况后，与健康素养充足的参与者相比，健康素养不足和边缘的参与者全因死亡率的风险比分别为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，受教育年限与死亡率的关联较弱，在多变量模型中不显著。健康素养不足的参与者经风险调整后的心血管疾病死亡率较高，但癌症死亡率不高。
以阅读流畅性衡量的健康素养不足独立预测社区居住老年人的全因死亡率和心血管疾病死亡率。在研究社会经济地位与健康之间的关联时，阅读流畅性是比教育更有力的变量。
