Program on Health Care Quality and Outcomes, Division of Health Services and Social Policy Research, RTI International, Research Triangle Park, North Carolina 27709-2194, USA.
Ann Intern Med. 2011 Jul 19;155(2):97-107. doi: 10.7326/0003-4819-155-2-201107190-00005.
BACKGROUND: Approximately 80 million Americans have limited health literacy, which puts them at greater risk for poorer access to care and poorer health outcomes. PURPOSE: To update a 2004 systematic review and determine whether low health literacy is related to poorer use of health care, outcomes, costs, and disparities in health outcomes among persons of all ages. DATA SOURCES: English-language articles identified through MEDLINE, CINAHL, PsycINFO, ERIC, and Cochrane Library databases and hand-searching (search dates for articles on health literacy, 2003 to 22 February 2011; for articles on numeracy, 1966 to 22 February 2011). STUDY SELECTION: Two reviewers independently selected studies that compared outcomes by differences in directly measured health literacy or numeracy levels. DATA EXTRACTION: One reviewer abstracted article information into evidence tables; a second reviewer checked information for accuracy. Two reviewers independently rated study quality by using predefined criteria, and the investigative team jointly graded the overall strength of evidence. DATA SYNTHESIS: 96 relevant good- or fair-quality studies in 111 articles were identified: 98 articles on health literacy, 22 on numeracy, and 9 on both. Low health literacy was consistently associated with more hospitalizations; greater use of emergency care; lower receipt of mammography screening and influenza vaccine; poorer ability to demonstrate taking medications appropriately; poorer ability to interpret labels and health messages; and, among elderly persons, poorer overall health status and higher mortality rates. Poor health literacy partially explains racial disparities in some outcomes. Reviewers could not reach firm conclusions about the relationship between numeracy and health outcomes because of few studies or inconsistent results among studies. LIMITATIONS: Searches were limited to articles published in English. No Medical Subject Heading terms exist for identifying relevant studies. No evidence concerning oral health literacy (speaking and listening skills) and outcomes was found. CONCLUSION: Low health literacy is associated with poorer health outcomes and poorer use of health care services. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.
背景：约有 8000 万美国人的健康素养有限，这使他们在获得医疗保健服务和改善健康结果方面面临更大的风险。
目的：更新 2004 年的系统评价，以确定健康素养低下是否与所有年龄段人群的医疗保健服务利用较差、结局较差、成本较高以及健康结局差异有关。
数据来源：通过 MEDLINE、CINAHL、PsycINFO、ERIC 和 Cochrane 图书馆数据库以及手工检索（健康素养相关文章的检索日期为 2003 年至 2011 年 2 月 22 日；计算能力相关文章的检索日期为 1966 年至 2011 年 2 月 22 日）获取英文文献。
研究选择：两位审查员独立选择了比较通过直接测量的健康素养或计算能力水平差异得出的结局的研究。
数据提取：一位审查员将文章信息提取到证据表中；第二位审查员检查信息的准确性。两位审查员使用预先确定的标准独立评估研究质量，研究团队共同对证据的总体强度进行分级。
数据综合：在 111 篇文章中确定了 96 项相关的高质量或良好质量的研究：98 篇关于健康素养，22 篇关于计算能力，9 篇同时涉及健康素养和计算能力。健康素养低下与更多的住院治疗、更多地使用急诊服务、更低的接受乳房 X 光筛查和流感疫苗的比例、更差的正确服用药物的能力、更差的解释标签和健康信息的能力以及老年人更差的整体健康状况和更高的死亡率有关。健康素养低下部分解释了某些结局方面的种族差异。由于研究较少或研究结果不一致，审查员无法就计算能力与健康结局之间的关系得出明确结论。
局限性：检索仅限于发表在英文期刊上的文章。没有用于确定相关研究的医学主题词。没有发现有关口腔健康素养（听说能力）和结局的证据。
结论：健康素养低下与较差的健康结局和较差的医疗保健服务利用有关。
主要资金来源：美国医疗保健研究与质量局。
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