Peterson Pamela N, Shetterly Susan M, Clarke Christina L, Bekelman David B, Chan Paul S, Allen Larry A, Matlock Daniel D, Magid David J, Masoudi Frederick A
Division of Cardiology, Denver Health Medical Center, Mail Code 0960, 777 Bannock St, Denver, CO 80204, USA.
JAMA. 2011 Apr 27;305(16):1695-701. doi: 10.1001/jama.2011.512.
Little is known about the effects of low health literacy among patients with heart failure, a condition that requires self-management and frequent interactions with the health care system.
To evaluate the association between low health literacy and all-cause mortality and hospitalization among outpatients with heart failure.
DESIGN, SETTING, AND PATIENTS: Retrospective cohort study conducted at Kaiser Permanente Colorado, an integrated managed care organization. Outpatients with heart failure were identified between January 2001 and May 2008, were surveyed by mail, and underwent follow-up for a median of 1.2 years. Health literacy was assessed using 3 established screening questions and categorized as adequate or low. Responders were excluded if they did not complete at least 1 health literacy question or if they did not have at least 1 year of enrollment prior to the survey date.
All-cause mortality and all-cause hospitalization.
Of the 2156 patients surveyed, 1547 responded (72% response rate). Of 1494 included responders, 262 (17.5%) had low health literacy. Patients with low health literacy were older, of lower socioeconomic status, less likely to have at least a high school education, and had higher rates of coexisting illnesses. In multivariable Cox regression, low health literacy was independently associated with higher mortality (unadjusted rate, 17.6% vs 6.3%; adjusted hazard ratio, 1.97 [95% confidence interval, 1.3-2.97]; P = .001) but not hospitalization (unadjusted rate, 30.5% vs 23.2%; adjusted hazard ratio, 1.05 [95% confidence interval, 0.8-1.37]; P = .73).
Among patients with heart failure in an integrated managed care organization, low health literacy was significantly associated with higher all-cause mortality.
对于心力衰竭患者中健康素养低下的影响所知甚少，而心力衰竭是一种需要自我管理且需频繁与医疗保健系统互动的疾病。
评估心力衰竭门诊患者中低健康素养与全因死亡率及住院率之间的关联。
设计、地点和患者：在凯撒永久医疗集团科罗拉多分部（一家综合性管理式医疗组织）进行的回顾性队列研究。2001年1月至2008年5月期间确定了心力衰竭门诊患者，通过邮件对其进行调查，并进行了为期中位数1.2年的随访。使用3个既定的筛查问题评估健康素养，并将其分类为充足或低下。如果应答者未完成至少1个健康素养问题，或在调查日期之前的参保时间不足1年，则将其排除。
全因死亡率和全因住院率。
在接受调查的2156名患者中，1547人作出了回应（应答率为72%）。在1494名纳入的应答者中，262人（17.5%）健康素养低下。健康素养低下的患者年龄较大，社会经济地位较低，至少接受过高中教育的可能性较小，并存疾病的发生率较高。在多变量Cox回归分析中，低健康素养与较高的死亡率独立相关（未调整率，17.6%对6.3%；调整后的风险比，1.97[95%置信区间，1.3 - 2.97]；P = 0.001），但与住院率无关（未调整率，30.5%对23.2%；调整后的风险比，1.05[95%置信区间，0.8 - 1.37]；P = 0.73）。
在一家综合性管理式医疗组织的心力衰竭患者中，低健康素养与较高的全因死亡率显著相关。
