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Med Care. 2014 Apr;52(4):346-53. doi: 10.1097/MLR.0000000000000101.

Association of health literacy with elevated blood pressure: a cohort study of hospitalized patients.

Author information

1
*Department of Emergency Medicine, Vanderbilt University †Department of Medicine and the Vanderbilt Center for Health Services Research, Division of General Internal Medicine and Public Health ‡Vanderbilt Center for Health Services Research §School of Nursing, Vanderbilt University ∥Department of Medicine and Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research Education Clinical Center (GRECC), Division of General Internal Medicine and Public Health, Nashville VA Medical Center, Nashville, TN.

Abstract

BACKGROUND:

The clinical consequences of low health literacy are not fully understood.

OBJECTIVES:

We evaluated the relationship between low health literacy and elevated blood pressure (BP) at hospital presentation.

RESEARCH DESIGN AND SUBJECTS:

We conducted a cross-sectional evaluation of adult patients hospitalized at a university hospital between November 1, 2010 and April 30, 2012.

MEASURES:

Health literacy was assessed using the Brief Health Literacy Screen (BHLS). Low health literacy was defined as a BHLS score ≤9. BP was assessed using clinical measurements. The outcome was elevated BP (≥140/90 mm Hg; ≥130/80 mm Hg with diabetes or renal disease) or extremely elevated BP (>160/100 mm Hg) at hospital presentation. Multivariate logistic regression adjusted for age, sex, race, insurance, comorbidities, and antihypertensive medications; preplanned restricted analysis among patients with diagnosed hypertension was performed.

RESULTS:

Of 46,263 hospitalizations, 23% had low health literacy, which occurred more often among patients who were older (61 vs. 54 y), less educated (28.4% vs. 11.2% had not completed high school), and more often admitted through the emergency department (54.3% vs. 48.1%) than those with BHLS>9. Elevated BP was more frequent among those with low health literacy [40.0% vs. 35.5%; adjusted odds ratio (aOR) 1.06; 95% confidence interval (CI), 1.01-1.12]. Low health literacy was associated with extremely elevated BP (aOR 1.08; 95% CI, 1.01-1.16) and elevated BP among those without diagnosed hypertension (aOR 1.09; 95% CI, 1.02-1.16).

CONCLUSIONS:

More than ⅓ of patients had elevated BP at hospital presentation. Low health literacy was independently associated with elevated BP, particularly among patients without diagnosed hypertension.

PMID:
24556896
PMCID:
PMC4031281
DOI:
10.1097/MLR.0000000000000101
[Indexed for MEDLINE]
Free PMC Article

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