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J Gen Intern Med. 2006 Aug;21(8):857-61.

Impact of health literacy on socioeconomic and racial differences in health in an elderly population.

Author information

1
Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. david.howard@emory.edu

Abstract

BACKGROUND:

Differences in health literacy levels by race and education are widely hypothesized to contribute to health disparities, but there is little direct evidence.

OBJECTIVE:

To examine the extent to which low health literacy exacerbates differences between racial and socioeconomic groups in terms of health status and receipt of vaccinations.

DESIGN:

Retrospective cohort study. PARTICIPANTS (OR PATIENTS OR SUBJECTS): Three thousand two hundred and sixty noninstitutionalized elderly persons enrolling in a Medicare managed care plan in 1997 in Cleveland, OH; Houston, TX; South Florida; and Tampa, FL.

MEASUREMENTS:

Dependent variables were physical health SF-12 score, mental health SF-12 score, self-reported health status, receipt of influenza vaccine, and receipt of pneumococcal vaccine. Independent variables included health literacy, educational attainment, race, income, age, sex, chronic health conditions, and smoking status.

RESULTS:

After adjusting for demographic and health-related variables, individuals without a high school education had worse physical and mental health and worse self-reported health status than those with a high school degree. Accounting for health literacy reduced these differences by 22% to 41%. Black individuals had worse self-reported health status and lower influenza and pneumococcal vaccination rates. Accounting for health literacy reduced the observed difference in self-reported health by 25% but did not affect differences in vaccination rates.

CONCLUSIONS:

We found that health literacy explained a small to moderate fraction of the differences in health status and, to a lesser degree, receipt of vaccinations that would normally be attributed to educational attainment and/or race if literacy was not considered.

PMID:
16881947
PMCID:
PMC1831584
DOI:
10.1111/j.1525-1497.2006.00530.x
[Indexed for MEDLINE]
Free PMC Article

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