Limited Literacy in Older People and Disparities in Health and Healthcare Access
Rebecca L. Sudore MD
From the * Department of Medicine, Division of Geriatrics, and Departments of † Epidemiology and Biostatistics, ‡ Neurology, and § Psychiatry, University of California, San Francisco, San Francisco, California; Departments of ∥ Epidemiology and ¶ Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania # Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee ** Department of Sociology, Kent State University, Kent, Ohio †† Clinical Research Branch, National Institute on Aging, Baltimore, Maryland ‡‡ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.
Search for more papers by this authorKala M. Mehta DSc
From the * Department of Medicine, Division of Geriatrics, and Departments of † Epidemiology and Biostatistics, ‡ Neurology, and § Psychiatry, University of California, San Francisco, San Francisco, California; Departments of ∥ Epidemiology and ¶ Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania # Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee ** Department of Sociology, Kent State University, Kent, Ohio †† Clinical Research Branch, National Institute on Aging, Baltimore, Maryland ‡‡ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.
Search for more papers by this authorEleanor M. Simonsick PhD
From the * Department of Medicine, Division of Geriatrics, and Departments of † Epidemiology and Biostatistics, ‡ Neurology, and § Psychiatry, University of California, San Francisco, San Francisco, California; Departments of ∥ Epidemiology and ¶ Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania # Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee ** Department of Sociology, Kent State University, Kent, Ohio †† Clinical Research Branch, National Institute on Aging, Baltimore, Maryland ‡‡ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.
Search for more papers by this authorTamara B. Harris MD
From the * Department of Medicine, Division of Geriatrics, and Departments of † Epidemiology and Biostatistics, ‡ Neurology, and § Psychiatry, University of California, San Francisco, San Francisco, California; Departments of ∥ Epidemiology and ¶ Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania # Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee ** Department of Sociology, Kent State University, Kent, Ohio †† Clinical Research Branch, National Institute on Aging, Baltimore, Maryland ‡‡ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.
Search for more papers by this authorAnne B. Newman MD, MPH
From the * Department of Medicine, Division of Geriatrics, and Departments of † Epidemiology and Biostatistics, ‡ Neurology, and § Psychiatry, University of California, San Francisco, San Francisco, California; Departments of ∥ Epidemiology and ¶ Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania # Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee ** Department of Sociology, Kent State University, Kent, Ohio †† Clinical Research Branch, National Institute on Aging, Baltimore, Maryland ‡‡ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.
Search for more papers by this authorSuzanne Satterfield MD
From the * Department of Medicine, Division of Geriatrics, and Departments of † Epidemiology and Biostatistics, ‡ Neurology, and § Psychiatry, University of California, San Francisco, San Francisco, California; Departments of ∥ Epidemiology and ¶ Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania # Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee ** Department of Sociology, Kent State University, Kent, Ohio †† Clinical Research Branch, National Institute on Aging, Baltimore, Maryland ‡‡ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.
Search for more papers by this authorCaterina Rosano MD, MPH
From the * Department of Medicine, Division of Geriatrics, and Departments of † Epidemiology and Biostatistics, ‡ Neurology, and § Psychiatry, University of California, San Francisco, San Francisco, California; Departments of ∥ Epidemiology and ¶ Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania # Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee ** Department of Sociology, Kent State University, Kent, Ohio †† Clinical Research Branch, National Institute on Aging, Baltimore, Maryland ‡‡ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.
Search for more papers by this authorRonica N. Rooks PhD
From the * Department of Medicine, Division of Geriatrics, and Departments of † Epidemiology and Biostatistics, ‡ Neurology, and § Psychiatry, University of California, San Francisco, San Francisco, California; Departments of ∥ Epidemiology and ¶ Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania # Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee ** Department of Sociology, Kent State University, Kent, Ohio †† Clinical Research Branch, National Institute on Aging, Baltimore, Maryland ‡‡ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.
Search for more papers by this authorSusan M. Rubin MPH
From the * Department of Medicine, Division of Geriatrics, and Departments of † Epidemiology and Biostatistics, ‡ Neurology, and § Psychiatry, University of California, San Francisco, San Francisco, California; Departments of ∥ Epidemiology and ¶ Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania # Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee ** Department of Sociology, Kent State University, Kent, Ohio †† Clinical Research Branch, National Institute on Aging, Baltimore, Maryland ‡‡ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.
Search for more papers by this authorHilsa N. Ayonayon PhD
From the * Department of Medicine, Division of Geriatrics, and Departments of † Epidemiology and Biostatistics, ‡ Neurology, and § Psychiatry, University of California, San Francisco, San Francisco, California; Departments of ∥ Epidemiology and ¶ Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania # Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee ** Department of Sociology, Kent State University, Kent, Ohio †† Clinical Research Branch, National Institute on Aging, Baltimore, Maryland ‡‡ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.
Search for more papers by this authorKristine Yaffe MD
From the * Department of Medicine, Division of Geriatrics, and Departments of † Epidemiology and Biostatistics, ‡ Neurology, and § Psychiatry, University of California, San Francisco, San Francisco, California; Departments of ∥ Epidemiology and ¶ Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania # Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee ** Department of Sociology, Kent State University, Kent, Ohio †† Clinical Research Branch, National Institute on Aging, Baltimore, Maryland ‡‡ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.
Search for more papers by this authorfor the Health, Aging and Body Composition Study
From the * Department of Medicine, Division of Geriatrics, and Departments of † Epidemiology and Biostatistics, ‡ Neurology, and § Psychiatry, University of California, San Francisco, San Francisco, California; Departments of ∥ Epidemiology and ¶ Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania # Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee ** Department of Sociology, Kent State University, Kent, Ohio †† Clinical Research Branch, National Institute on Aging, Baltimore, Maryland ‡‡ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.
Search for more papers by this authorRebecca L. Sudore MD
From the * Department of Medicine, Division of Geriatrics, and Departments of † Epidemiology and Biostatistics, ‡ Neurology, and § Psychiatry, University of California, San Francisco, San Francisco, California; Departments of ∥ Epidemiology and ¶ Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania # Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee ** Department of Sociology, Kent State University, Kent, Ohio †† Clinical Research Branch, National Institute on Aging, Baltimore, Maryland ‡‡ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.
Search for more papers by this authorKala M. Mehta DSc
From the * Department of Medicine, Division of Geriatrics, and Departments of † Epidemiology and Biostatistics, ‡ Neurology, and § Psychiatry, University of California, San Francisco, San Francisco, California; Departments of ∥ Epidemiology and ¶ Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania # Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee ** Department of Sociology, Kent State University, Kent, Ohio †† Clinical Research Branch, National Institute on Aging, Baltimore, Maryland ‡‡ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.
Search for more papers by this authorEleanor M. Simonsick PhD
From the * Department of Medicine, Division of Geriatrics, and Departments of † Epidemiology and Biostatistics, ‡ Neurology, and § Psychiatry, University of California, San Francisco, San Francisco, California; Departments of ∥ Epidemiology and ¶ Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania # Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee ** Department of Sociology, Kent State University, Kent, Ohio †† Clinical Research Branch, National Institute on Aging, Baltimore, Maryland ‡‡ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.
Search for more papers by this authorTamara B. Harris MD
From the * Department of Medicine, Division of Geriatrics, and Departments of † Epidemiology and Biostatistics, ‡ Neurology, and § Psychiatry, University of California, San Francisco, San Francisco, California; Departments of ∥ Epidemiology and ¶ Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania # Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee ** Department of Sociology, Kent State University, Kent, Ohio †† Clinical Research Branch, National Institute on Aging, Baltimore, Maryland ‡‡ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.
Search for more papers by this authorAnne B. Newman MD, MPH
From the * Department of Medicine, Division of Geriatrics, and Departments of † Epidemiology and Biostatistics, ‡ Neurology, and § Psychiatry, University of California, San Francisco, San Francisco, California; Departments of ∥ Epidemiology and ¶ Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania # Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee ** Department of Sociology, Kent State University, Kent, Ohio †† Clinical Research Branch, National Institute on Aging, Baltimore, Maryland ‡‡ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.
Search for more papers by this authorSuzanne Satterfield MD
From the * Department of Medicine, Division of Geriatrics, and Departments of † Epidemiology and Biostatistics, ‡ Neurology, and § Psychiatry, University of California, San Francisco, San Francisco, California; Departments of ∥ Epidemiology and ¶ Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania # Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee ** Department of Sociology, Kent State University, Kent, Ohio †† Clinical Research Branch, National Institute on Aging, Baltimore, Maryland ‡‡ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.
Search for more papers by this authorCaterina Rosano MD, MPH
From the * Department of Medicine, Division of Geriatrics, and Departments of † Epidemiology and Biostatistics, ‡ Neurology, and § Psychiatry, University of California, San Francisco, San Francisco, California; Departments of ∥ Epidemiology and ¶ Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania # Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee ** Department of Sociology, Kent State University, Kent, Ohio †† Clinical Research Branch, National Institute on Aging, Baltimore, Maryland ‡‡ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.
Search for more papers by this authorRonica N. Rooks PhD
From the * Department of Medicine, Division of Geriatrics, and Departments of † Epidemiology and Biostatistics, ‡ Neurology, and § Psychiatry, University of California, San Francisco, San Francisco, California; Departments of ∥ Epidemiology and ¶ Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania # Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee ** Department of Sociology, Kent State University, Kent, Ohio †† Clinical Research Branch, National Institute on Aging, Baltimore, Maryland ‡‡ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.
Search for more papers by this authorSusan M. Rubin MPH
From the * Department of Medicine, Division of Geriatrics, and Departments of † Epidemiology and Biostatistics, ‡ Neurology, and § Psychiatry, University of California, San Francisco, San Francisco, California; Departments of ∥ Epidemiology and ¶ Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania # Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee ** Department of Sociology, Kent State University, Kent, Ohio †† Clinical Research Branch, National Institute on Aging, Baltimore, Maryland ‡‡ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.
Search for more papers by this authorHilsa N. Ayonayon PhD
From the * Department of Medicine, Division of Geriatrics, and Departments of † Epidemiology and Biostatistics, ‡ Neurology, and § Psychiatry, University of California, San Francisco, San Francisco, California; Departments of ∥ Epidemiology and ¶ Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania # Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee ** Department of Sociology, Kent State University, Kent, Ohio †† Clinical Research Branch, National Institute on Aging, Baltimore, Maryland ‡‡ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.
Search for more papers by this authorKristine Yaffe MD
From the * Department of Medicine, Division of Geriatrics, and Departments of † Epidemiology and Biostatistics, ‡ Neurology, and § Psychiatry, University of California, San Francisco, San Francisco, California; Departments of ∥ Epidemiology and ¶ Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania # Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee ** Department of Sociology, Kent State University, Kent, Ohio †† Clinical Research Branch, National Institute on Aging, Baltimore, Maryland ‡‡ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.
Search for more papers by this authorfor the Health, Aging and Body Composition Study
From the * Department of Medicine, Division of Geriatrics, and Departments of † Epidemiology and Biostatistics, ‡ Neurology, and § Psychiatry, University of California, San Francisco, San Francisco, California; Departments of ∥ Epidemiology and ¶ Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania # Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee ** Department of Sociology, Kent State University, Kent, Ohio †† Clinical Research Branch, National Institute on Aging, Baltimore, Maryland ‡‡ Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland.
Search for more papers by this authorThe results of this study were presented at the Society of General Internal Medicine Annual Meeting, Chicago, Illinois, June 2004, and the American Academy of the Physician and Patient Annual Meeting, Indianapolis, Indiana, October 2004.
Abstract
OBJECTIVES: To determine the relationship between health literacy, demographics, and access to health care.
DESIGN: Cross-sectional study, Health, Aging and Body Composition data (1999/2000).
SETTING: Memphis, Tennessee, and Pittsburgh, Pennsylvania.
PARTICIPANTS: Two thousand five hundred twelve black and white community-dwelling older people who were well functioning at baseline (without functional difficulties or dementia).
MEASUREMENTS: Participants' health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine. Scores were categorized into 0 to sixth-, seventh- to eighth-, and ninth-grade and higher reading levels (limited health literacy defined as <9th grade). Participants' demographics, socioeconomic status, comorbidities, and three indicators of healthcare access (whether they had a doctor/regular place of medical care, an influenza vaccination within the year, or insurance for medications) were also assessed.
RESULTS: Participants' mean age was 75.6, 52% were female, 38% were black, and 24% had limited health literacy. After adjusting for sociodemographics, associations remained between limited health literacy and being male, being black, and having low income and education, diabetes mellitus, depressive symptoms, and fair/poor self-rated health (P<.02). After adjusting for sociodemographics, health status, and comorbidities, older people with a sixth-grade reading level or lower were twice as likely to have any of the three indicators of poor healthcare access (odds ratio=1.96, 95% confidence interval=1.34–2.88).
CONCLUSION: Limited health literacy was prevalent and was associated with low socioeconomic status, comorbidities, and poor access to health care, suggesting that it may be an independent risk factor for health disparities in older people.
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