Article Figures & Data
Figures
- Figure 1.
Conceptual model: the mediation effect of health literacy on racial/ethnic and educational disparities in health and preventive health behaviors in older adults.
Tables
- Table 1.
Characteristics of Older Adults in Households by Dependent and Independent Variables
Variables Frequencya Weighted Percentage (SE) Note: Standard errors are in parentheses. Detail may not sum to totals because of rounding. Older adults are defined as people aged 65 years and older living in households. Source: Data used are from the 2003 National Assessment of Adult Literacy, conducted by the National Center for Education Statistics, Institute of Education Sciences, US Department of Education. a Unweighted absolute frequency in sample. b High school diploma or equivalency degree. c Self-reported utilization of care in the year preceding the assessment. Independent Variables Health literacy level Below basic 950 29.0 (1.4) Basic 736 29.5 (0.8) Intermediate 894 38.2 (1.3) Proficient 85 3.3 (0.5) Race/ethnicity White (non-Hispanic) 2,037 85.3 (1.3) Black (non-Hispanic) 352 7.3 (0.9) Latino/Hispanic 209 5.1 (1.0) Other 70 2.3 (0.7) Education >High school 987 37.3 (1.5) High schoolb 788 38.5 (1.4) <High school 888 24.3 (1.4) Age 65–74 y 1,439 55.2 (1.2) 75–84 y 988 36.5 (1.1) 85+ y 241 8.3 (0.8) Sex Male 1,036 44.9 (1.1) Female 1,632 55.1 (1.1) Income Above 175% threshold 1,141 58.6 (1.6) 100%–175% above threshold 594 23.0 (1.4) Below poverty threshold 584 18.4 (1.3) Nativity US born 2,421 92.2 (0.9) Foreign born 246 7.8 (0.9) Dependent Variables Self-rated health status Fair/poor 887 29.3 (1.1) Excellent/very good/good 1,777 70.7 (1.1) Influenza vaccinationc No 793 27.7 (1.4) Yes 1,866 72.3 (1.4) Mammogramc No 576 34.0 (1.7) Yes 1,041 66.0 (1.7) Dental checkupc No 1,154 39.3 (1.6) Yes 1,506 60.7 (1.6) - Table 2.
Percentage of US Adults Aged 65 Years and Older Reporting Poor or Fair Self-Reported Health and Utilization of Preventive Care Services by Race/Ethnicity and Educational Attainment
Variable Poor or Fair Self-rated Health Status % (95% CI) Influenza Vaccination % (95% CI) Mammogram % (95% CI) Dental Checkup % (95% CI) Source: Data used are from the 2003 National Assessment of Adult Literacy, conducted by the National Center for Education Statistics, Institute of Education Sciences, US Department of Education. a High school diploma or equivalency degree. b P <.05. Race/ethnicity White 27 (24–29)b 74 (71–77)b 65 (62–69) 63 (59–66)b Black 49 (41–56)b 59 (53–65)b 68 (58–77) 44 (38–51)b Hispanic 41 (32–50)b 63 (52–73)b 75 (68–82) 56 (46–65)b Educational attainment >High School 20 (16–24)b 76 (72–80)b 76 (71–81)b 77 (73–81)b High Schoola 27 (23–30)b 74 (68–78)b 62 (56–68)b 60 (56–65)b <High School 48 (43–53)b 64 (59–69)b 59 (53–65)b 35 (30–40)b - Table 3.
Results From Probit Regression Models Used to Examine the Mediation Effect of Health Literacy on Disparities in Selected Health Outcomes Related to Race/Ethnicity and Educational Attainment (Model A = Without Health Literacy, Model B = With Health Literacy)
Self-Rated Health Status β (SE) Influenza Vaccination β (SE) Mammogram β (SE) Dental Checkup β (SE) Variable A B A B A B A B MML=marginal maximum likelihood. Note: Standard errors are in parentheses. Three decimal places were kept when reporting standard error estimates of age. The small estimates were due to a much larger unit of age compared with other independent variables. Model A has self-rated health status or utilization of each of the preventive health services as the dependent variable, race/ethnicity and educational attainment as the independent variable, and 4 demographic variables as covariates. Model B adds health literacy as an independent variable. Source: Data used are from the 2003 National Assessment of Adult Literacy, conducted by the National Center for Education Statistics, Institute of Education Sciences, US Department of Education. a Statistically significant regression coefficients in each model at the α level of .05. b In the MML probit model, health literacy was measured on the item response theory (IRT) 𝛉 scale, typically ranging from −3 to 3. c Sex is not included in the probit model for mammogram. Race/ethnicity White Ref Ref Ref Ref Ref Ref Ref Ref Black −0.34a (0.11) −0.24a (0.04) −0.24a (0.10) −0.18a (0.04) 0.23 (0.15) 0.28a (0.06) −0.13 (0.11) −0.04 (0.04) Latino/Hispanic 0.02 (0.14) 0.21a (0.07) −0.04 (0.16) 0.08 (0.07) 0.57a (0.19) 0.70a (0.07) 0.19 (0.14) 0.35a (0.05) Other −0.11 (0.30) −0.09 (0.10) 0.22 (0.19) 0.24a (0.08) −0.01 (0.25) 0.02 (0.09) −0.21 (0.32) −0.20 (0.12) Education >High school Ref Ref Ref Ref Ref Ref Ref Ref High school or equivalency −0.17 (0.11) −0.08 (0.05) −0.08 (0.10) −0.03 (0.04) −0.40a (0.14) −0.36a (0.06) −0.39a (0.10) −0.31a (0.04) <High school −0.56a (0.12) −0.36a (0.05) −0.31a (0.11) −0.18a (0.05) −0.60a (0.13) −0.46a (0.06) −0.97a (0.12) −0.80a (0.05) Health literacyb – 0.23a (0.03) – 0.14a (0.02) – 0.17a (0.04) – 0.20a (0.03) Age −0.02a (0.006) −0.01a (0.003) 0.03a (0.006) 0.03a (0.003) −0.01 (0.007) −0.006 (0.003) 0.008 (0.005) 0.02a (0.002) Sexc Male Ref Ref Ref Ref – – Ref Ref Female 0.19a (0.08) 0.15a (0.03) 0.04 (0.08) 0.01 (0.03) – – 0.12 (0.08) 0.07a (0.03) Income >175% of poverty level Ref Ref Ref Ref Ref Ref Ref Ref 100%–175% poverty level −0.39a (0.11) −0.32a (0.04) −0.07 (0.10) −0.03 (0.04) −0.23 (0.12) −0.18a (0.05) −0.55a (0.10) −0.49a (0.04) <Poverty level −0.62a (0.11) −0.50a (0.05) −0.23a (0.10) −0.16a (0.05) −0.14 (0.13) 0.04 (0.05) −0.54a (0.13) −0.43a (0.06) Nativity US born Ref Ref Ref Ref Ref Ref Ref Ref Foreign born −0.03 (0.17) 0.10 (0.07) −0.24 (0.13) −0.16a (0.05) −0.12 (0.22) 0.04 (0.10) 0.18 (0.15) 0.30a (0.06) Constant 2.34a (0.50) 1.77a (0.22) −1.13a (0.45) −1.52a (0.19) 1.77a (0.52) 1.32a (0.25) 0.22 (0.35) −0.33a (0.16)
Supplemental Tables 1-2
Supplemental Table 1. Adjusted Relationship of Race/Ethnicity and Educational Attainment to Health Literacy for US Adults Aged 65 Years and Older in Households, Based on Marginal Maximum Likelihood (MML)Regression; Supplemental Table 2. Sobel Tests of Significant Mediation Effects of Health Literacy
Files in this Data Supplement:
- Supplemental data: Tables 1-2 - PDF file, 2 pages, 96 KB
The Article in Brief
The Contribution of Health Literacy to Disparities in Self-Rated Health Status and Preventive Health Behaviors in Older Adults
Ian M. Bennett , and colleagues
Background This study of older adults looks at the relationship between preventive health services, health disparities (gaps in the quality of health and health care between different groups), and health literacy (the ability to use health information to make health decisions).
What This Study Found Among older adults, health literacy contributes to racial/ethnic and education-related disparities in self-rated health status and receipt of influenza vaccination. Education-related disparities are also associated with receipt of mammography and dental care.
Implications
- Health disparities in older adults might be reduced by efforts to improve their health literacy and lower the reading level of print materials aimed at them. Further research of these approaches is needed.
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