Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Imperial College and Nanyang Technological University, Singapore City, Singapore.
Department of Psychology, National University of Singapore, Singapore.
Br J Health Psychol. 2020 Sep;25(3):405-427. doi: 10.1111/bjhp.12413. Epub 2020 Apr 18.
Objectives Health literacy encompasses a broad skill set linked to patients' self-management ability and the complexity of their health care environments. Self-management in the context of multimorbidity is particularly challenging, placing patients at risk of poor clinical outcomes. This study aimed to explore the prognostic associations between health literacy domains, depression, and 12-month health care utilization and mortality in patients with diabetes and end-stage renal disease (DM-ESRD). Design Observational study. Methods Patients with DM-ESRD undergoing haemodialysis were recruited. Information on all-cause hospitalization/admission and mortality of participants was recorded. Negative binomial and Cox regressions were used to model risk factors for hospitalization and mortality. Results A total 221 participants [median age: 59 years, 61.6% men, 54.8% Chinese] were recruited. Differences in health literacy were found as a function of age, ethnicity, relationship status, and education. After adjusting for demographic and clinical factors, the HLQ domain Actively Managing My Health remained independently associated with lower rates of hospitalization (incidence rate ratio (IRR) = 0.674, 95% CI [0.490, 0.925], p = .02) and mortality (hazard ratio = 0.382, 95% CI [0.160, 0.848], p = .02). Cumulative hospitalization days were associated with employment status (IRR = 2.242, 95% CI [1.223, 4.113], p = .009), albumin (IRR = 0.918, 95% CI [0.854, 0.988], p = .02), HbA1c (IRR = 1.183, 95% CI [1.028, 1.360], p = .02), comorbidity burden (IRR = 1.137, 95% CI [1.003, 1.289], p = .04), and depression (IRR = 1.059, 95% CI [1.003, 1.118], p = .04) but no health literacy domains. Conclusions Health literacy skills related to Actively Managing My Health predict hospitalization and mortality independently of other risk factors. The HLQ provides an assessement of novel health literacy parameters which offer new insights into patients' status and behaviours and may strengthen interventions to improve clinical services, and patient outcomes in DM-ESRD. Statement of contribution What is already known on this subject? Patients with diabetes (DM) comprise the fastest growing segment of patients with end-stage renal disease (ESRD). Health literacy (HL) is pivotal for managing the complex treatment guidelines for DM-ESRD. Most prior work on HL focused on functional HL and shown significant associations with mortality and hospitalization. Limited research has investigated wider HL skills in relation to clinical outcomes. What does this study add? Supporting patients in Actively Managing my health liteacy skills is critical in decreasing probability of hospitalization and morbidity. The presence of symptoms of depression is associated with longer hospitalization period.
目的 健康素养涵盖了与患者自我管理能力和医疗环境复杂性相关的广泛技能。在多种疾病共存的情况下，自我管理尤其具有挑战性，使患者面临不良临床结局的风险。本研究旨在探讨健康素养领域、抑郁与糖尿病和终末期肾病（DM-ESRD）患者 12 个月内医疗保健利用和死亡率之间的预后关联。
设计 观察性研究。
方法 招募接受血液透析的 DM-ESRD 患者。记录参与者的全因住院/入院和死亡率信息。使用负二项式和 Cox 回归来模拟住院和死亡率的风险因素。
结果 共纳入 221 名参与者[中位年龄：59 岁，61.6%为男性，54.8%为中国人]。发现健康素养存在差异，与年龄、种族、婚姻状况和教育程度有关。在调整人口统计学和临床因素后，HLQ 主动管理我的健康领域与较低的住院率（发病率比（IRR）=0.674，95%CI[0.490，0.925]，p=0.02）和死亡率（风险比=0.382，95%CI[0.160，0.848]，p=0.02）独立相关。累积住院天数与就业状况（IRR=2.242，95%CI[1.223，4.113]，p=0.009）、白蛋白（IRR=0.918，95%CI[0.854，0.988]，p=0.02）、HbA1c（IRR=1.183，95%CI[1.028，1.360]，p=0.02）、合并症负担（IRR=1.137，95%CI[1.003，1.289]，p=0.04）和抑郁（IRR=1.059，95%CI[1.003，1.118]，p=0.04）有关，但与健康素养领域无关。
结论 与主动管理我的健康相关的健康素养技能可独立于其他风险因素预测住院和死亡率。HLQ 提供了对新的健康素养参数的评估，这些参数为患者的状况和行为提供了新的见解，并可能加强干预措施，以改善 DM-ESRD 患者的临床服务和预后。
