David H. Howard|Tetine Sentell|Julie A. Gazmararian
Impact of health literacy on socioeconomic and racial differences in health in an elderly population
Emory University|University of California, San Francisco|Emory University
differences health literacy levels race education widely hypothesized contribute health disparities little direct evidenceto examine extent low health literacy exacerbates differences racial socioeconomic groups terms health status receipt vaccinationsretrospective cohort study participants patients subjects three thousand two hundred sixty noninstitutionalized elderly persons enrolling medicare managed care plan 1997 cleveland oh houston tx south florida tampa fldependent variables physical health sf12 score mental health sf12 score selfreported health status receipt influenza vaccine receipt pneumococcal vaccine independent variables included health literacy educational attainment race income age sex chronic health conditions smoking statusafter adjusting demographic healthrelated variables individuals without high school education worse physical mental health worse selfreported health status high school degree accounting health literacy reduced differences 22 41 black individuals worse selfreported health status lower influenza pneumococcal vaccination rates accounting health literacy reduced observed difference selfreported health 25 affect differences vaccination rateswe found health literacy explained small moderate fraction differences health status lesser degree receipt vaccinations would normally attributed educational attainment andor race literacy considered