Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94118, USA.
J Gen Intern Med. 2013 Jan;28(1):74-81. doi: 10.1007/s11606-012-2177-3. Epub 2012 Aug 14.
Limited health literacy is associated with poor outcomes in many chronic diseases, but little is known about health literacy in chronic obstructive pulmonary disease (COPD).
To examine the associations between health literacy and both outcomes and health status in COPD. PARTICIPANTS, DESIGN AND MAIN MEASURES: Structured interviews were administered to 277 subjects with self-report of physician-diagnosed COPD, recruited through US random-digit telephone dialing. Health literacy was measured with a validated three-item battery. Multivariable linear regression, controlling for sociodemographics including income and education, determined the cross-sectional associations between health literacy and COPD-related health status: COPD Severity Score, COPD Helplessness Index, and Airways Questionnaire-20R [measuring respiratory-specific health-related quality of life (HRQoL)]. Multivariable logistic regression estimated associations between health literacy and COPD-related hospitalizations and emergency department (ED) visits.
Taking socioeconomic status into account, poorer health literacy (lowest tertile compared to highest tertile) was associated with: worse COPD severity (+2.3 points; 95 % CI 0.3-4.4); greater COPD helplessness (+3.7 points; 95 % CI 1.6-5.8); and worse respiratory-specific HRQoL (+3.5 points; 95 % CI 1.8-4.9). Poorer health literacy, also controlling for the same covariates, was associated with higher likelihood of COPD-related hospitalizations (OR = 6.6; 95 % CI 1.3-33) and COPD-related ED visits (OR = 4.7; 95 % CI 1.5-15). Analyses for trend across health literacy tertiles were statistically significant (p < 0.05) for all above outcomes.
Independent of socioeconomic status, poor health literacy is associated with greater COPD severity, greater COPD helplessness, worse respiratory-specific HRQoL, and higher odds of COPD-related emergency health-care utilization. These results underscore that COPD patients with poor health literacy may be at particular risk for poor health-related outcomes.
有限的健康素养与许多慢性疾病的不良结局有关，但关于慢性阻塞性肺疾病（COPD）的健康素养知之甚少。
探讨健康素养与 COPD 患者结局和健康状况之间的关系。
参与者、设计和主要措施：通过美国随机数字电话拨号系统，对 277 名自我报告经医生诊断为 COPD 的患者进行了结构访谈。采用经过验证的三项目电池来测量健康素养。多元线性回归，控制社会人口统计学因素，包括收入和教育，确定了健康素养与 COPD 相关健康状况之间的横断面关系：COPD 严重程度评分、COPD 无助感指数和气道问卷-20R[测量呼吸特异性健康相关生活质量（HRQoL）]。多变量逻辑回归估计了健康素养与 COPD 相关住院和急诊部（ED）就诊之间的关系。
考虑到社会经济地位，较差的健康素养（与最高三分位相比，最低三分位）与以下情况相关：COPD 严重程度恶化（增加 2.3 分；95%CI 0.3-4.4）；COPD 无助感增加（增加 3.7 分；95%CI 1.6-5.8）；呼吸特异性 HRQoL 恶化（增加 3.5 分；95%CI 1.8-4.9）。同样控制了上述相同的协变量，较差的健康素养与 COPD 相关住院（OR=6.6；95%CI 1.3-33）和 COPD 相关 ED 就诊（OR=4.7；95%CI 1.5-15）的可能性增加相关。健康素养三分位组之间的趋势分析在所有上述结局中均具有统计学意义（p<0.05）。
独立于社会经济地位，较差的健康素养与 COPD 严重程度增加、COPD 无助感增加、呼吸特异性 HRQoL 恶化以及 COPD 相关急诊医疗保健利用的可能性增加相关。这些结果强调，健康素养较差的 COPD 患者可能面临较差的健康相关结局的特殊风险。
