Journal of General Internal Medicine

, Volume 28, Issue 1, pp 74–81

Lower Health Literacy is Associated with Poorer Health Status and Outcomes in Chronic Obstructive Pulmonary Disease

  • Theodore A. Omachi
  • Urmimala Sarkar
  • Edward H. Yelin
  • Paul D. Blanc
  • Patricia P. Katz
Original Research

DOI: 10.1007/s11606-012-2177-3

Cite this article as:
Omachi, T.A., Sarkar, U., Yelin, E.H. et al. J GEN INTERN MED (2013) 28: 74. doi:10.1007/s11606-012-2177-3

ABSTRACT

BACKGROUND

Limited health literacy is associated with poor outcomes in many chronic diseases, but little is known about health literacy in chronic obstructive pulmonary disease (COPD).

OBJECTIVE

To examine the associations between health literacy and both outcomes and health status in COPD.

PARTICIPANTS, DESIGN AND MAIN MEASURES

Structured interviews were administered to 277 subjects with self-report of physician-diagnosed COPD, recruited through US random-digit telephone dialing. Health literacy was measured with a validated three-item battery. Multivariable linear regression, controlling for sociodemographics including income and education, determined the cross-sectional associations between health literacy and COPD-related health status: COPD Severity Score, COPD Helplessness Index, and Airways Questionnaire-20R [measuring respiratory-specific health-related quality of life (HRQoL)]. Multivariable logistic regression estimated associations between health literacy and COPD-related hospitalizations and emergency department (ED) visits.

KEY RESULTS

Taking socioeconomic status into account, poorer health literacy (lowest tertile compared to highest tertile) was associated with: worse COPD severity (+2.3 points; 95 % CI 0.3–4.4); greater COPD helplessness (+3.7 points; 95 % CI 1.6–5.8); and worse respiratory-specific HRQoL (+3.5 points; 95 % CI 1.8–4.9). Poorer health literacy, also controlling for the same covariates, was associated with higher likelihood of COPD-related hospitalizations (OR = 6.6; 95 % CI 1.3–33) and COPD-related ED visits (OR = 4.7; 95 % CI 1.5–15). Analyses for trend across health literacy tertiles were statistically significant (p < 0.05) for all above outcomes.

CONCLUSIONS

Independent of socioeconomic status, poor health literacy is associated with greater COPD severity, greater COPD helplessness, worse respiratory-specific HRQoL, and higher odds of COPD-related emergency health-care utilization. These results underscore that COPD patients with poor health literacy may be at particular risk for poor health-related outcomes.

KEY WORDS

chronic obstructive pulmonary disease health literacy health status health outcomes utilization 

Abbreviations

AQ-20R

Airways Questionnaire-20R

CHI

COPD Helplessness Index

CI

confidence interval

COPD

chronic obstructive pulmonary disease

ED

emergency department

HRQoL

health-related quality of life

OR

odds ratio

MCID

minimum clinically important difference

SD

standard deviation

Supplementary material

11606_2012_2177_MOESM1_ESM.docx (32 kb)
ESM 1(DOCX 31 kb)

Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Theodore A. Omachi
    • 1
    • 2
  • Urmimala Sarkar
    • 3
    • 4
  • Edward H. Yelin
    • 5
    • 6
  • Paul D. Blanc
    • 2
    • 7
  • Patricia P. Katz
    • 5
    • 6
  1. 1.Division of Pulmonary, Critical Care, and Sleep Medicine, Department of MedicineUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Cardiovascular Research InstituteUniversity of California, San FranciscoSan FranciscoUSA
  3. 3.Division of General Internal Medicine, Department of MedicineUniversity of California, San FranciscoSan FranciscoUSA
  4. 4.Center for Vulnerable PopulationsSan Francisco General HospitalSan FranciscoUSA
  5. 5.Institute for Health Policy StudiesUniversity of California, San FranciscoSan FranciscoUSA
  6. 6.Division of Rheumatology, Department of MedicineUniversity of California, San FranciscoSan FranciscoUSA
  7. 7.Division of Occupational and Environmental Medicine, Department of MedicineUniversity of California, San FranciscoSan FranciscoUSA

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