Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands.
Department of Internal Medicine, Rheumatology Division, Maastricht University Medical Center+, Maastricht, The Netherlands.
Rheumatology (Oxford). 2023 Oct 3;62(10):3409-3415. doi: 10.1093/rheumatology/kead094.
The aim of this study was to explore the longitudinal associations between health literacy profiles and disease activity and medication prescription in patients with RA.
Patients with RA who previously completed the Health Literacy Questionnaire (HLQ) and were assigned 1 of 10 distinct health literacy profiles based on cluster analysis were further aggregated into three groups: 'several health literacy limitations', 'some health literacy limitations' and 'good health literacy'. Linear mixed modelling (LMM) was used to analyse the association between health literacy groups and disease activity over the course of 1 year. Chi-squared tests and logistic regression analyses were used to compare medication prescriptions between the groups.
A total of 108 patients with RA were included. LMM showed a significant effect of health literacy group on disease activity over time (P = 0.010). Patients with 'good health literacy' had significantly lower disease activity over time [28-joint DAS with ESR (DAS28-ESR) = 2.4] than patients with 'several health literacy limitations' (DAS28-ESR = 3.1), independent of age, gender and education level. Patients with 'good health literacy' were most often prescribed a biologic DMARD (50%), whereas patients with 'some health literacy limitations' more commonly received a conventional synthetic DMARD only [72.7%; odds ratio (OR) 4.24], and patients with 'several health literacy limitations' were more often prescribed prednisolone (52.4%; OR 3.56).
Significant differences in longitudinal disease activity and medication prescription were observed between groups with different health literacy levels. These results stress the importance of insights into the role of health literacy in treatment and outcomes in patients with RA.
本研究旨在探讨健康素养特征与类风湿关节炎（RA）患者疾病活动度和药物处方之间的纵向关联。
先前完成健康素养问卷（HLQ）且基于聚类分析被分为 10 种不同健康素养特征之一的 RA 患者进一步被分为三组：“多种健康素养受限”“某些健康素养受限”和“良好健康素养”。线性混合模型（LMM）用于分析健康素养组与 1 年内疾病活动度之间的关系。卡方检验和逻辑回归分析用于比较各组之间的药物处方。
共纳入 108 例 RA 患者。LMM 显示健康素养组对疾病活动度的时间变化有显著影响（P=0.010）。随着时间的推移，“良好健康素养”患者的疾病活动度显著降低[28 关节疾病活动度（DAS28-ESR）=2.4]，而“多种健康素养受限”患者的疾病活动度则升高[DAS28-ESR=3.1]，且与年龄、性别和教育水平无关。“良好健康素养”患者最常被开具生物 DMARD（50%），而“某些健康素养受限”患者则更常被开具传统合成 DMARD（72.7%；优势比[OR]4.24），“多种健康素养受限”患者则更常被开具泼尼松龙（52.4%；OR 3.56）。
不同健康素养水平组之间观察到疾病活动度和药物处方的纵向差异具有统计学意义。这些结果强调了了解健康素养在 RA 患者治疗和结局中的作用的重要性。
