Kim Hee-Sun, Kim Jinhee
National Evidence-Based Collaborating Agency, Seoul 04933, Republic of Korea.
Department of Nursing, Chosun University College of Medicine, Gwangju 61452, Republic of Korea.
Healthcare (Basel). 2025 Jun 3;13(11):1331. doi: 10.3390/healthcare13111331.
This study aims to examine the mediating effects of health literacy on the relationship between frailty and medical costs among community-dwelling older adults. This study conducted a secondary data analysis of the research data that were constructed by linking the Korean Frailty and Aging Cohort Data (KFACD) and the National Health Insurance Database (NHID). Frailty was measured using the Modified Fried Phenotype. Medical costs were calculated using insurance-covered medical costs, including both inpatient and outpatient medical costs, from January 1 to December 31 of the year when the participants were enrolled in the Korean Frailty and Aging Cohort Study. Health literacy was assessed using questions from the Behavioral Risk Factor Surveillance System (BRFSS) conducted by the US Centers for Disease Control and Prevention. To examine the mediating role of health literacy in the relationship between frailty and medical costs, Baron and Kenny's method was used. Linear regression was applied to estimate the association between frailty and health literacy, and Poisson regression was used to model the relationship between frailty, health literacy, and medical costs. Frailty showed a negative correlation with health literacy (r = -0.27, < 0.001) and a positive correlation with medical costs (r = 0.15, < 0.001). Health literacy had a negative correlation with medical costs (r = -0.07, = 0.008). We verified that health literacy played a partial mediating role in the relationship between frailty and medical costs. To reduce medical costs in older adults, intervention measures to improve health literacy as well as prevention and management measures for frailty should be considered simultaneously. In addition, primary medical institutions' active participation in such projects is needed.
本研究旨在探讨健康素养在社区老年人虚弱与医疗费用关系中的中介作用。本研究对通过链接韩国虚弱与老龄化队列数据（KFACD）和国民健康保险数据库（NHID）构建的研究数据进行了二次数据分析。使用改良的弗里德表型来衡量虚弱程度。医疗费用是根据参与者参加韩国虚弱与老龄化队列研究当年1月1日至12月31日期间包括住院和门诊医疗费用在内的保险覆盖医疗费用来计算的。使用美国疾病控制与预防中心进行的行为危险因素监测系统（BRFSS）中的问题来评估健康素养。为了检验健康素养在虚弱与医疗费用关系中的中介作用，采用了巴伦和肯尼的方法。应用线性回归来估计虚弱与健康素养之间的关联，并使用泊松回归来模拟虚弱、健康素养与医疗费用之间的关系。虚弱与健康素养呈负相关（r = -0.27，< 0.001），与医疗费用呈正相关（r = 0.15，< 0.001）。健康素养与医疗费用呈负相关（r = -0.07，= 0.008）。我们证实健康素养在虚弱与医疗费用的关系中起到了部分中介作用。为了降低老年人的医疗费用，应同时考虑提高健康素养的干预措施以及虚弱的预防和管理措施。此外，基层医疗机构需要积极参与此类项目。
