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Annals of Family Medicine 7:204-211 (2009)
© 2009 Annals of Family Medicine, Inc.
doi: 10.1370/afm.940
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The Contribution of Health Literacy to Disparities in Self-Rated Health Status and Preventive Health Behaviors in Older Adults

Ian M. Bennett, MD, PhD1,2,3, Jing Chen, PhD4, Jaleh S. Soroui, MLS4 and Sheida White, PhD5

1 Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
2 Leonard Davis Institute of Health Economics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
3 Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania
4 American Institutes for Research, Washington, DC
5 National Center for Education Statistics, US Department of Education, Washington, DC

CORRESPONDING AUTHOR: Ian Bennett, MD, PhD, 2nd Floor, Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104, ian.bennett{at}uphs.upenn.edu

PURPOSE Health literacy is associated with a range of poor health-related outcomes. Evidence that health literacy contributes to disparities in health is minimal and based on brief screening instruments that have limited ability to assess health literacy. The purpose of this study was to assess whether health literacy contributes, through mediation, to racial/ethnic and education-related disparities in self-rated health status and preventive health behaviors among older adults.

METHODS We undertook a cross-sectional study of a nationally representative sample of 2,668 US adults aged 65 years and older from the 2003 National Assessment of Adult Literacy. Multiple regression analysis was used to assess for evidence of mediation.

RESULTS Of older adults in the United States, 29% reported fair or poor health status, and 27% to 39% reported not utilizing 3 recommended preventive health care services in the year preceding the assessment (influenza vaccination 27%, mammography 34%, dental checkup 39%). Health literacy and the 4 health outcomes (self-rated health status and utilization of the 3 preventive health care services) varied by race/ethnicity and educational attainment. Regression analyses indicated that, after controlling for potential confounders, health literacy significantly mediated both racial/ethnic and education-related disparities in self-rated health status and receipt of influenza vaccination, but only education-related disparities in receipt of mammography and dental care.

CONCLUSIONS Health literacy contributes to disparities associated with race/ethnicity and educational attainment in self-rated health and some preventive health behaviors among older adults. Interventions addressing low health literacy may reduce these disparities.

Key Words: Aged • preventive health services • educational status • vaccination • oral health




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TRACK Comments:

Read all TRACK Comments

Health literacy and health status - one more piece of evidence
Barry D Weiss
Annals of Family Medicine, 17 May 2009 [Full text]
Response
Ian M. Bennett
Annals of Family Medicine, 17 May 2009 [Full text]
Could Education Mediate Literacy?
Kelly Marvin Jeppesen
Annals of Family Medicine, 22 May 2009 [Full text]
Health Information Literacy Intervention Soon Available
Jean P. Shipman
Annals of Family Medicine, 14 Jun 2009 [Full text]
Resources for health providers
Ian M. Bennett
Annals of Family Medicine, 15 Jun 2009 [Full text]

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