Journal of General Internal Medicine

, Volume 21, Issue 8, pp 857–861

Impact of health literacy on socioeconomic and racial differences in health in an elderly population

  • David H. Howard
  • Tetine Sentell
  • Julie A. Gazmararian
Original Articles

DOI: 10.1111/j.1525-1497.2006.00530.x

Cite this article as:
Howard, D.H., Sentell, T. & Gazmararian, J.A. J GEN INTERN MED (2006) 21: 857. doi:10.1111/j.1525-1497.2006.00530.x


BACKGROUND: Differences in health literacy levels by race and education are widely hypothesized to contribute to health disparities, but there is little direct evidence.

OBJECTIVE: To examine the extent to which low health literacy exacerbates differences between racial and socioeconomic groups in terms of health status and receipt of vaccinations.

DESIGN: Retrospective cohort study.

PARTICIPANTS (OR PATIENTS OR SUBJECTS): Three thousand two hundred and sixty noninstitutionalized elderly persons enrolling in a Medicare managed care plan in 1997 in Cleveland, OH; Houston, TX: South Florida; and Tampa, FL.

MEASUREMENTS: Dependent variables were physical health SF-12 score, mental health SF-12 score, self-reported health status, receipt of influenza vaccine, and receipt of pneumococcal vaccine. Independent variables included health literacy, educational attainment, race, income, age, sex, chronic health conditions, and smoking status.

RESULTS: After adjusting for demographic and health-related variables, individuals without a high school education had worse physical and mental health and worse self-reported health status than those with a high school degree. Accounting for health literacy reduced these differences by 22% to 41%. Black individuals had worse self-reported health status and lower influenza and pneumococcal vaccination rates. Accounting for health literacy reduced the observed difference in self-reported health by 25% but did not affect differences in vaccination rates.

CONCLUSIONS: We found that health literacy explained a small to moderate fraction of the differences in health status and, to a lesser degree, receipt of vaccinations that would normally be attributed to educational attainment and/or race if literacy was not considered.

Key words

educational statushealth literacyhealth statusminority groups

Copyright information

© Society of General Internal Medicine 2006

Authors and Affiliations

  • David H. Howard
    • 1
  • Tetine Sentell
    • 2
  • Julie A. Gazmararian
    • 3
  1. 1.Department of Health Policy and Management, Rollins School of Public HealthEmory UniversityAtlanta
  2. 2.Department of PsychiatryUniversity of California, San FranciscoSan FranciscoUSA
  3. 3.Emory Center on Health Outcomes and QualityEmory UniversityAtlantaUSA