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J Diabetes Complications. 2018 Apr;32(4):368-372. doi: 10.1016/j.jdiacomp.2017.10.012. Epub 2017 Oct 28.

The relationship of health literacy to diabetes status differs by sex in older adults.

Author information

1
Division of Endocrinology, Diabetes & Metabolism, The Johns Hopkins University, Baltimore, MD, United States.
2
Intramural Research Program National Institute on Aging, Baltimore, MD, United States.
3
Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, United States; San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States.
4
Hopkins Center for Health Disparities Solution, The Johns Hopkins University, Baltimore, MD, United States.
5
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States.
6
Division of Endocrinology, Diabetes & Metabolism, The Johns Hopkins University, Baltimore, MD, United States; Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD, United States; The Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, United States.
7
Division of Endocrinology, Diabetes & Metabolism, The Johns Hopkins University, Baltimore, MD, United States; The Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, United States. Electronic address: rrastogi@jhmi.edu.

Abstract

OBJECTIVE:

Lower health literacy is associated with higher rates of mortality and chronic disease. It remains unclear whether health literacy is associated with diabetes and/or hyperglycemia in older adults, and if this relationship differs by sex.

RESEARCH DESIGN AND METHODS:

We performed a cross-sectional analysis of 2510 older adults in the Health, Aging and Body Composition (Health ABC) Study who had both a Rapid Estimate of Adult Literacy in Medicine (REALM) measurement and diabetes status available. Sex-stratified logistic regression models were used to analyze the relationship of health literacy categories (low, medium, and high) to diabetes status, adjusting for key covariates. Secondary analyses examined the relationship of health literacy to glycemic markers (A1C, fasting blood glucose).

RESULTS:

Among participants in the Health ABC cohort, 429 had diabetes. Mean age was 76years old and 45% were female. Men with diabetes more commonly had low health literacy levels than men without diabetes (10.1% versus 9.3%, p=0.02). Similar results were seen among women (14.7% versus 6.1%, p<0.01). In a model adjusting for age, race, income, education, BMI, smoking, and alcohol use, women with low versus high health literacy had a two-fold higher likelihood of diabetes (OR=2.2; 95% CI 1.1-4.3). No significant relationship was observed in men. Progressively lower categories of health literacy were associated with higher age-adjusted mean A1C and fasting blood glucose levels in women (both p for trend <0.01) but not men.

CONCLUSIONS:

In this large, ethnically diverse sample of community-dwelling older adults, lower health literacy level is related to a greater likelihood of diabetes and higher A1C and fasting blood glucose levels in women-but not in men-after adjusting for age, race, and other demographic and lifestyle factors. Future studies are needed to assess mechanisms underlying this relationship and if interventions to improve health literacy are effective in reducing the burden of diabetes, particularly in women.

KEYWORDS:

Diabetes mellitus; Health literacy; Hyperglycemia; Older adults; Sex differences

PMID:
29198996
PMCID:
PMC5849497
DOI:
10.1016/j.jdiacomp.2017.10.012
[Indexed for MEDLINE]
Free PMC Article

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