Division of Urology, Maine Medical Center, Portland, Maine; Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, Maine; Tufts University School of Medicine, Boston, Massachusetts.
Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
Am J Prev Med. 2021 Feb;60(2):e69-e72. doi: 10.1016/j.amepre.2020.08.018. Epub 2020 Dec 17.
Health literacy affects how patients behave within the healthcare system. Overutilization of screening procedures inconsistent with the U.S. Preventive Services Task Force guidelines contributes to the high cost of health care. The authors hypothesize that higher health literacy supports guideline-concordant screening. This study assesses the effect of health literacy on nonrecommended prostate, breast, and cervical cancer screening in patients older than the recommended screening age limit.
The 2016 Behavioral Risk Factor Surveillance System included health literacy modules. Respondents self-reported their ability to obtain and understand health information, resulting in 4 health literacy rankings. The authors calculated the population-weighted proportion of respondents in each health literacy category who underwent screening past the Task Force‒recommended age limit. The ORs of nonrecommended screening for each malignancy were calculated, with low health literacy as the ref category.
Individuals with higher health literacy underwent more nonrecommended screening. Nonrecommended prostate cancer screening was performed in 27.4% (95% CI=23.7%, 31.4%) and 47.7% (95% CI=44.1%, 51.3%) of respondents with low and high health literacy, respectively (p<0.001). Nonrecommended breast cancer screening was performed in 46.8% (95% CI=42.6%, 51.1%) and 67.7% (95% CI=64.2%, 71.1%) of respondents with low and high health literacy, respectively (p=0.002). Nonrecommended cervical cancer screening was performed in 33.8% (95% CI=31.1%, 36.5%) and 48.4% (95% CI=46.3%, 50.5%) of respondents with low and high health literacy, respectively (p<0.001). Individuals with high health literacy were significantly more likely than those with low health literacy to screen against the recommendations for prostate (OR=1.73, 95% CI=1.34, 2.23, p<0.001), cervical (OR=1.533, 95% CI=1.31, 1.80, p<0.001), and breast (OR=8.213, 95% CI=4.90, 13.76, p<0.001) cancer.
Higher health literacy correlates with increased rates of screening beyond the recommended age, contrary to the study hypothesis. Breast cancer demonstrated the highest rates of nonrecommended screening.
健康素养影响患者在医疗体系中的行为。不符合美国预防服务工作组指南的筛查程序的过度使用导致医疗保健成本高昂。作者假设更高的健康素养支持符合指南的筛查。本研究评估了健康素养对推荐筛查年龄以上患者中不推荐的前列腺癌、乳腺癌和宫颈癌筛查的影响。
2016 年行为风险因素监测系统包括健康素养模块。受访者自我报告获取和理解健康信息的能力，从而得出 4 个健康素养排名。作者计算了每个健康素养类别中接受推荐年龄以上筛查的受访者的人口加权比例。计算了每种恶性肿瘤非推荐筛查的比值比，低健康素养为参考类别。
具有较高健康素养的个体进行了更多的非推荐筛查。低健康素养和高健康素养的受访者分别有 27.4%（95%CI=23.7%，31.4%）和 47.7%（95%CI=44.1%，51.3%）（p<0.001）进行了不推荐的前列腺癌筛查。低健康素养和高健康素养的受访者分别有 46.8%（95%CI=42.6%，51.1%）和 67.7%（95%CI=64.2%，71.1%）（p=0.002）进行了不推荐的乳腺癌筛查。低健康素养和高健康素养的受访者分别有 33.8%（95%CI=31.1%，36.5%）和 48.4%（95%CI=46.3%，50.5%）（p<0.001）进行了不推荐的宫颈癌筛查。与低健康素养者相比，高健康素养者更有可能对前列腺癌（OR=1.73，95%CI=1.34，2.23，p<0.001）、宫颈癌（OR=1.533，95%CI=1.31，1.80，p<0.001）和乳腺癌（OR=8.213，95%CI=4.90，13.76，p<0.001）的推荐筛查建议进行筛查。
与研究假设相反，较高的健康素养与推荐年龄以上的筛查率增加有关。乳腺癌显示出最高的非推荐筛查率。
