Low Health Literacy and Mortality in Individuals with Cardiovascular Disease, Chronic Obstructive Pulmonary Disease, Diabetes, and Mental Illness: A 6-Year Population-Based Follow-Up Study.

Karina Friis,Mathias Lasgaard,Anna Aaby,Richard H Osborne,Helle Terkildsen Maindal,Marie Hauge Pedersen

doi:10.3390/ijerph17249399

Abstract

Background: The objective of the study was to examine the impact of health literacy on mortality in the general population and among individuals with cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), diabetes, and mental illness. Methods: Data from a large Danish health survey (n = 29,473) from 2013 were linked with national mortality registry data to permit a 6-year follow-up. Results: Individuals reporting difficulties in understanding information about health, had higher risk of dying during follow-up (hazard rate (HR) 1.38 (95% CI 1.11–1.73)) compared with those without difficulties. Higher risk was also observed among people reporting CVD (HR 1.47 (95% CI 1.01–2.14)), diabetes (HR 1.91 (95% CI 1.13–3.22)) and mental illness (HR 2.18 (95% CI 1.25–3.81)), but not for individuals with COPD. Difficulties in actively engaging with healthcare providers was not associated with an increase in the risk of dying in the general population or in any of the four long-term condition groups. Conclusions: Aspects of health literacy predict a higher risk of dying during a 6-year follow-up period. Our study serves as a reminder to healthcare organizations to consider the health literacy responsiveness of their services in relation to diverse health literacy challenges and needs.

Highlights

The persistence of social inequality in life expectancy is a major public health concern [1,2].One of the mechanisms underlying social inequality in health may be found in the concept of health literacy, which captures the difficulties people may encounter in navigating healthcare systems
The mean age was lowest among individuals with mental illness (48.1 years) and ranged from 63.6 years to 66.1 years in the three other chronic condition groups
This study showed that individuals who find it difficult to understand information about health have a 1.4-fold higher mortality risk after 6 years than individuals who do not report difficulties in understanding health information

Summary

Introduction

One of the mechanisms underlying social inequality in health may be found in the concept of health literacy, which captures the difficulties people may encounter in navigating healthcare systems. Health literacy is defined as the personal competences and situational resources needed for people to access, understand, appraise and use information and services to make health-related decisions. The objective of the study was to examine the impact of health literacy on mortality in the general population and among individuals with cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), diabetes, and mental illness. Results: Individuals reporting difficulties in understanding information about health, had higher risk of dying during follow-up (hazard rate (HR) 1.38 Higher risk was observed among people reporting CVD (HR 1.47 (95% CI 1.01–2.14)), diabetes (HR 1.91 (95% CI 1.13–3.22)) and mental illness (HR 2.18 (95% CI 1.25–3.81)), but not for individuals with COPD. Our study serves as a reminder to healthcare organizations to consider the health literacy responsiveness of their services in relation to diverse health literacy challenges and needs

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Methods

Results

Discussion

Conclusion