Objective: Previous research suggests that literacy level may be a better predictor of cognitive performance than years of education in minoritized groups. Although literacy tests remain a mainstay in the context of neuropsychological evaluations due to their role in the estimation of premorbid intellectual functioning, there is relatively little research examining the role of literacy in the relationship between ethnicity and cognitive performance. This study examined whether literacy level influences the relationship between ethnicity and letter fluency ability. Method: This cross-sectional study included 64 adult patients consecutively referred for outpatient neuropsychological evaluation within a large, Midwestern academic medical center. The sample was 54.7% male, 43.8% White, 56.3% Black, with Mage of 57.8 years (SD=11.7) and Meducation of 12.6 years (SD=2.5). A mediation analysis was performed using Hayes’ PROCESS macro within SPSS to evaluate whether literacy, as measured by the Test of Premorbid Functioning (TOPF), mediated the association between ethnicity (dichotomized as Black/White) and letter fluency via raw scores from the F/A/S trials. Results: The main model of the mediation analysis was significant, F (4, 51) = 13.89, p <.001, R2 = .521. After accounting for age and years of education, there was a significant mediation effect of literacy on the relationship between ethnicity and letter fluency (B = .740, SE = .143, t = 5.19, p <.001). Conclusion(s): In sum, this study provided evidence that literacy level helps explain the letter fluency performance differences observed between Black and White patients.

Objective: Health literacy and numeracy are commonly associated with health disparities and may disproportionately affect minoritized groups. This study assessed racial disparities in health literacy and numeracy and their association to sociodemographic and psychological risk factors among a mixed clinical outpatient sample. Method: Cross-sectional data from 198 patients who were administered the General Health Numeracy Test-Short Form (GHNT), Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R), Adverse Childhood Experiences Checklist (ACE), Perceived Stress Scale (PSS), and Test of Premorbid Functioning-Predicted FSIQ (TOPF-FSIQ) were examined. Participant characteristics were compared by ethnoracial group status via chi-square and ANOVA tests. Multivariate regression models evaluated associations between health literacy and numeracy with sociodemographic and psychological risk factors across ethnoracial groups. Results: Subjects were 45% female/55% male, 48% White, 38% Black and 14% Hispanic, with a Mage of 44.7 (SD = 17.3) and Meducation of 13.5 years (SD = 2.8). Black subjects were older, less educated, and had lower TOPF-FSIQ than White subjects, whereas Hispanic subjects were younger with lower TOPF-FSIQ than White subjects. Black subjects had lower GHNT-6 and REALM-R scores than White subjects. No group differences in ACE or PSS were observed. In multivariate analyses, only lower TOPF-FSIQ was significantly associated with lower REALM-R, whereas lower TOPF-FSIQ, older age, and higher ACEs were significantly associated with lower GHNT. No significant interactions with ethnoracial group status were observed. Conclusion(s): Although health literacy and numeracy differed across ethnoracial groups, this effect was driven by lower TOPF-FSIQ for health literacy, in addition to lower age and higher number of adverse childhood experiences for health numeracy.