David W. Baker
Health Literacy and Mortality Among Elderly Persons
Emory University|Northwestern University
individuals low levels health literacy less health knowledge worse selfmanagement chronic disease lower use preventive services worse health crosssectional studies sought determine whether low health literacy levels independently predict overall causespecific mortalitywe designed prospective cohort study 3260 medicare managedcare enrollees 4 us metropolitan areas interviewed 1997 determine demographic characteristics chronic conditions selfreported physical mental health health behaviors participants also completed shortened version test functional health literacy adults main outcome measures included allcause causespecific cardiovascular cancer mortality using data national death index 2003the crude mortality rates participants adequate n 2094 marginal n 366 inadequate n 800 health literacy 189 287 394 respectively p 001 adjusting demographics socioeconomic status baseline health hazard ratios allcause mortality 152 95 confidence interval 126183 113 95 confidence interval 090141 participants inadequate marginal health literacy respectively compared participants adequate health literacy contrast years school completed weakly associated mortality bivariate analyses significant multivariate models participants inadequate health literacy higher riskadjusted rates cardiovascular death death due cancerinadequate health literacy measured reading fluency independently predicts allcause mortality cardiovascular death among communitydwelling elderly persons reading fluency powerful variable education examining association socioeconomic status health