Healthcare Illiteracy Linked To Higher Mortality Among Elderly

07-25-2007 | Categories:

Health Literacy and Mortality Among Elderly Persons
David W. Baker, MD, MPH; Michael S. Wolf, PhD, MPH; Joseph Feinglass, PhD; Jason A. Thompson, BA; Julie A. Gazmararian, PhD; Jenny Huang, PhD. Arch Intern Med. 2007;167:1503-1509.


The Study

The study looked prospectively at 3260 Medicare managed-care enrollees in 4 US metropolitan areas who were interviewed in 1997 to determine their demographic characteristics, chronic conditions, self-reported physical and mental health, and health behaviors. Participants also completed the shortened version of the Test of Functional Health Literacy in Adults. Main outcome measures included all-cause and cause-specific (cardiovascular, cancer, and other) mortality using data from the National Death Index through 2003.

Results

The crude mortality rates for participants with adequate (n = 2094), marginal (n = 366), and inadequate (n = 800) health literacy were 18.9%, 28.7%, and 39.4%, respectively (P less than .001). After adjusting for demographics, socioeconomic status, and baseline health, the hazard ratios for all-cause mortality were 1.52 (95% confidence interval, 1.26-1.83) and 1.13 (95% confidence interval, 0.90-1.41) for participants with inadequate and marginal health literacy, respectively, compared with participants with adequate health literacy. In contrast, years of school completed was only weakly associated with mortality in bivariate analyses and was not significant in multivariate models. Participants with inadequate health literacy had higher risk-adjusted rates of cardiovascular death but not of death due to cancer.


Commentary

Adherence to treatment for chronic illnesses such as asthma, diabetes and heart disease can be difficult in the best of circumstances. For those with literacy problems, following a treatment plan that goes beyond “take the blue pill twice a day” may prove impossible without extensive and expensive assistance. And, as this study indicates, the inability to follow treatment instructions is deadly.

While campaigns to end illiteracy may be a long term solution, the immediate problem of millions of individuals who today cannot comprehend written medical information should prompt further work in alternative means of communicating this information.



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