Limited literacy and mortality in the elderly
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BACKGROUND: While limited literacy is common and its prevalence increases with age, no prospective study has assessed whether limited literacy is associated with mortality in older adults.
OBJECTIVE: To assess the association of limited literacy with mortality.
DESIGN AND SETTING: Five-year prospective study from 1999 to 2004 of community-dwelling elders from Memphis, TN, and Pittsburgh, PA, who were from the Health, Aging, and Body Composition study. Subjects’ literacy was assessed with the Rapid Estimate of Adult Literacy in Medicine. Scores were categorzied into limited (0 to 8th grade reading level) or adequate literacy (≥9th grade reading level).
PARTICIPANTS: Two thousand five hundred and twelve black and white elders without baseline functional difficulties or dementia.
MEASUREMENTS: Time to death.
RESULTS: Participants’ mean age was 75.6 years, 48% were male, 38% were black, and 24% had limited literacy; the median follow-up time was 4.2 years. Compared with those with adequate literacy, those with limited literacy had a higher risk of death (19.7% vs 10.6%) with a hazard ratio (HR) of 2.03 (95% confidence intervals [CI], 1.62 to 2.55). After adjusting for demographics and socioeconomic status, co-morbid conditions, self-rated health status, health-related behaviors, health care access measures, and psychosocial status, limited literacy remained independently associated with mortality (HR 1.75; 95% CI, 1.27 to 2.41).
CONCLUSIONS: Limited literacy is independently associated with a nearly 2-fold increase in mortality in the elderly. Given the growth of the aging population and the prevalence of chronic diseases, the mechanisms by which limited literacy is associated with mortality in the elderly warrant further investigation.
- Limited literacy and mortality in the elderly
Journal of General Internal Medicine
Volume 21, Issue 8 , pp 806-812
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- Author Affiliations
- 1. San Francisco VAMC, University of California, 4150 Clement Street, Box 181G, 94121, San Francisco, CA
- 2. University of Tennessee, Memphis, TN, USA
- 3. Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD, USA
- 4. Clinical Research Branch, National Institute on Aging, Baltimore, MD, USA
- 5. University of Pittsburgh, Pittsburgh, PA, USA
- 6. Kent State University, Kent, OH, USA