Abstract P394: Health Literacy Within a Diverse Community-Based Cohort: The Multi-Ethnic Study of Atherosclerosis

Abstract

Introduction: In 2018 the American Heart Association released a Scientific Statement on the importance of health literacy to cardiovascular disease (CVD) primary and secondary prevention. Health literacy has been defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” However, most studies exploring the prevalence of health literacy have been conducted in populations that were demographically relatively homogeneous. Hypothesis: Using cross-sectional data from the race-ethnically diverse, sex-balanced and community-based Multi-Ethnic Study of Atherosclerosis (MESA), we tested the hypotheses that low health literacy was associated with older age, lower income and less acculturation. Methods: Four standard questions assessing health literacy were asked during annual phone follow up encounters which took place from August 2016 through August 2018. The questions assessed: 1) ability to read materials received from a doctor, 2) problems learning about health conditions, 3) confidence in filling out medical forms, and 4) understanding of medical statistics. Consistent with prior literature, responses to the 4 questions were combined into a composite score, and then a dichotomous variable was created to classify health literacy as low or adequate. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated, adjusted for age, sex, and race/ethnicity. Race/ethnicity-stratified associations were also explored. Results: Our sample consisted of 3,638 adults ages 53-94 years (median, 69), including 1,513 White, 445 Chinese, 936 Black, and 734 Hispanic participants. A total of 15.4% had low health literacy, which was more common among elderly [PR (95% CI) for ≥70 years vs. <70 years: 2.24 (1.92, 2.61)], female [1.23 (1.07, 1.42)] and lower income [3.56 (2.82, 4.49)] participants, respectively. A higher prevalence of low health literacy was observed among participants who were Chinese, [PR (95% CI): 5.22 (4.15, 6.55)] Hispanic [4.94 (3.97, 6.14)], and Black [1.35 (1.01, 1.79)], relative to white participants. Acculturation factors such as non-US place of birth, fewer generations in the United States, and language other than English spoken in the home were all also associated with lower health literacy. When stratified by race/ethnicity, patterns of health literacy with age, sex, income and acculturation were similar to findings from the full study population. Conclusions: Within a diverse population low health literacy was more common among individuals who were older, female, had lower income, and were less acculturated. Since patients with low health literacy may need additional support to optimize their cardiovascular health, our results illustrate possible priority populations for health education intervention.