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Am J Emerg Med. 2011 Oct;29(8):875-82. doi: 10.1016/j.ajem.2010.03.031. Epub 2010 Jul 13.

Health literacy of adults presenting to an urban ED.

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Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minn 55415, USA.



The aim of the study was to assess the prevalence of limited health literacy in an urban emergency department (ED) and its association with sociodemographic variables.


This was a cross-sectional study of patients presenting to the ED of an urban county hospital. For 3 months, we screened a convenience sample of patients presenting to the ED. Participants completed a brief demographic survey and a validated assessment of health literacy, the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Multinomial logistic regression model was used to analyze data.


Of the 15,930 patients presenting to the ED, 5601 met inclusion criteria. Of eligible patients, 65% (3639) agreed to complete demographic surveys and 26% (960) of them agreed to complete the S-TOFHLA. The most common exclusions were inability to contact the patient and age less than 18 years. Participating patients were younger than those who declined (mean age, 36.8 compared to 40.8 [t = 7.49; P < .001]). Sex and ethnicity were not significantly different across groups. Of all participants, 15.5% possessed limited health literacy. Inadequate health literacy was independently associated with increasing age (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.05-1.10), non-English primary language (OR, 6.97; 95% CI, 2.76-17.6), male sex (OR, 1.82; 95% CI, 1.03-3.21), nonwhite ethnicity (OR, 2.66; 95% CI, 1.40-5.04), and years of education in the United States (OR, 0.63; 95% CI, 0.42-0.92). Marginal health literacy was associated with increasing age (OR, 1.03; 95% CI, 1.00-1.05); male sex (OR, 1.84; 95% CI, 1.04-3.24); ethnicity (OR, 2.08; 95% CI, 1.12-3.85); and a housing status of homelessness (OR, 9.66; 95% CI, 2.33-40.0), living with friends (OR, 4.59; 95% CI, 1.18-17.9), or renting (OR, 4.16; 95% CI, 1.21-14.3). Moderate to high correlation among housing variables was observed.


Of patients enrolled in the study, 15.5% have limited health literacy. Age, male sex, non-English first language, nonwhite ethnicity, limited education, and unstable housing were associated with limited health literacy.

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