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

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.

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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

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Acknowledgments

Dr. Omachi was supported by K23 HL102159 from the National Heart, Lung, and Blood Institute, National Institutes of Health. Dr. Katz, Dr. Blanc, and recruitment of the cohort were supported by R01 HL067438 from the National Heart, Lung, and Blood Institute, National Institutes of Health.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Correspondence to Theodore A. Omachi MD, MBA.

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Omachi, T.A., Sarkar, U., Yelin, E.H. et al. Lower Health Literacy is Associated with Poorer Health Status and Outcomes in Chronic Obstructive Pulmonary Disease. J GEN INTERN MED 28, 74–81 (2013). https://doi.org/10.1007/s11606-012-2177-3

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  • DOI: https://doi.org/10.1007/s11606-012-2177-3

KEY WORDS

  • chronic obstructive pulmonary disease
  • health literacy
  • health status
  • health outcomes
  • utilization