RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202, USA.
J Gen Intern Med. 2011 Jan;26(1):45-50. doi: 10.1007/s11606-010-1488-5. Epub 2010 Aug 31.
Coronary heart disease (CHD) is a leading cause of morbidity and mortality. Reducing the disease burden requires an understanding of factors associated with the prevention and management of CHD. Literacy skills may be one such factor.
To examine the independent and interactive effects of four literacy skills: reading, numeracy, oral language (speaking) and aural language (listening) on calculated 10-year risk of CHD and to determine whether the relationships between literacy skills and CHD risk were similar for men and women.
We used multivariable linear regression to assess the individual, combined, and interactive effects of the four literacy skills on risk of CHD, adjusting for education and race.
Four hundred and nine English-speaking adults in Boston, MA and Providence, RI.
Ten-year risk of coronary heart disease was calculated using the Framingham algorithm. Reading, oral language and aural language were measured using the Woodcock Johnson III Tests of Achievement. Numeracy was assessed through a modified version of the numeracy scale by Lipkus and colleagues.
When examined individually, reading (p = 0.007), numeracy (p = 0.001) and aural language (p = 0.004) skills were significantly associated with CHD risk among women; no literacy skills were associated with CHD risk in men. When examined together, there was some evidence for an interaction between numeracy and aural language among women suggesting that higher skills in one area (e.g., aural language) may compensate for difficulties in another resulting in an equally low risk of CHD.
Results of this study not only provide important insight into the independent and interactive effects of literacy skills on risk of CHD, they also highlight the need for the development of easy-to use assessments of the oral exchange in the health care setting and the need to better understand which literacy skills are most important for a given health outcome.
冠心病（CHD）是发病率和死亡率的主要原因。减轻疾病负担需要了解与 CHD 的预防和管理相关的因素。读写能力可能是这样的一个因素。
研究四种读写能力（阅读、计算、口语（说）和听力（听））对 CHD 发生 10 年风险的独立和交互作用，并确定读写能力与 CHD 风险之间的关系是否在男性和女性中相似。
我们使用多元线性回归来评估四种读写能力对 CHD 风险的个体、综合和交互作用，调整了教育和种族因素。
马萨诸塞州波士顿和罗得岛州普罗维登斯的 409 名讲英语的成年人。
使用 Framingham 算法计算冠心病的 10 年风险。阅读、口语和听力使用 Woodcock-Johnson III 成就测验进行测量。计算能力通过 Lipkus 及其同事的计算量表的修改版本进行评估。
当单独检查时，阅读（p = 0.007）、计算（p = 0.001）和听力（p = 0.004）技能与女性 CHD 风险显著相关；在男性中，没有读写能力与 CHD 风险相关。当一起检查时，女性中存在计算能力和听力之间相互作用的一些证据，这表明在一个领域（例如听力）的更高技能可能会弥补另一个领域的困难，从而导致 CHD 风险同样低。
这项研究的结果不仅提供了关于读写能力对 CHD 风险的独立和交互作用的重要见解，还强调了在医疗保健环境中开发易于使用的口头交流评估方法的必要性，以及需要更好地了解哪些读写能力对于给定的健康结果是最重要的。
