The relationship between socioeconomic position and health literacy among urban and rural adults in regional China

Wei Chen,Na Wang,Yaqing Xiong,Fei Xu,Hongfu Ren

doi:10.1186/s12889-021-10600-7

Abstract

BackgroundTo examine associations of socioeconomic position (SEP), separately indicated by education, monthly family average income (FAI) and occupation, with health literacy (HL) among adults in regional China.MethodsA cross-sectional survey was conducted among urban and rural adults (aged 25–69 years) who were randomly selected, using the probability proportionate to size sampling approach, from Nanjing municipality of China during October and December of 2016. HL, the outcome variable, was assessed using the Chinese Resident Health Literacy Scale. SEP, our independent variable, was separately measured with educational attainment, monthly family average income and occupation. Logistic regression models were introduced to examine SEP-HL association with odds ratio (OR) and 95% confidence interval (CI).ResultsTotally, 8698 participants completed the survey. The proportion of participants with unweighted and weighted adequate HL was 18.0% (95%CI = 17.2, 18.8%) and 19.9% (95%CI = 16.6, 23.6%), respectively, in this study. After adjustment for possible confounding factors, each SEP indicator was in significantly positive relation to both unweighted and weight HL level. Participants who obtained 13+ and 10–12 years educational attainment, respectively, had 2.41 (95%CI = 1.60, 3.64) and 1.68 (95%CI = 1.23, 2.29) times odds to record weighted adequate HL compared to their counterparts who were with 0–9 years education. Subjects within upper (OR = 1.92, 95%CI = 1.24, 2.98) and middle FAI tertile (OR = 1.59, 95%CI = 1.19, 2.13), respectively, were more likely to report weighted adequate HL relative to those who were within lower FAI tertile. White collars were more likely to have weighted adequate HL (OR = 1.33, 95%CI = 1.09, 1.61) than blue collars.ConclusionsEach of education, FAI and occupation was positively associated with health literacy among urban and rural adults in China. The findings have important implications that different SEP indicators can be used to identify vulnerable residents in population-based health literacy promotion campaigns.

Highlights

To examine associations of socioeconomic position (SEP), separately indicated by education, monthly family average income (FAI) and occupation, with health literacy (HL) among adults in regional China
SEP is a useful indicator for identifying sub-populations who are vulnerable to inadequate HL, and subsequently tailored community-based HL intervention strategies can be developed for SEP-specific sub-populations
No significant difference was found in age, gender or residential area between our participants and the overall residents aged 25–69 years in this study, showing that the participants were representative of the local overall population

Summary

Introduction

To examine associations of socioeconomic position (SEP), separately indicated by education, monthly family average income (FAI) and occupation, with health literacy (HL) among adults in regional China. Health literacy (HL) was defined by the World Health Organization (WHO) as the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information for promoting and maintaining good health [1] It has been well-documented that low HL was associated with unhealthy lifestyle/behaviors and poor health outcomes in both developing and developed countries [2,3,4,5,6,7]. A single indicator of SEP regarding income, monthly family average income (FAI), was developed, with consideration of total household income and the number of household members, for population-based studies on association of SEP with diabetes, obesity, stroke in China, showing that it was more realistic and sensitive as a single SEP indicator [15,16,17]

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Discussion

Conclusion