Association between occupational situation and health literacy: A Danish population-based survey

Abstract

Background It is well known, that health literacy is associated with health, and that occupation and health is associated as well. But current knowledge on the relationship between occupation and health literacy is scarce. The aim of this study was to examine the association of occupation with health literacy. Methods Between 2016 and 2017 a random sample of the Danish population participated in a cross-sectional national representative survey using the short version of the European Health Literacy Survey Questionnaire. 15,682 adults aged 25 years or older was invited, and 8,997 residents participated. Data on occupational situation were obtained from nationwide administrative registries, which contains information on employment and public benefits. Logistic regression was conducted for the binary outcome of health literacy and the exposure variable of occupational situation. Model was adjusted for sex, age, immigration, education, cohabitation and income. Subsequently, a mediation analysis was conducted to analyze if health literacy was a causal pathway in the association between occupational situation and health. Results Respondents receiving unemployment benefits had a significantly higher risk of inadequate health literacy [OR = 1.66 (p < 0.001)] compared to respondents who were employed. The associations were also significant for social assistance [OR = 1.63 (p < 0.001)], employment and support allowance [OR = 1.59 (p < 0.001)], and sickness benefit [OR = 1.55 (p < 0.001)]. Mediation analysis showed, that the association between employment status and health were partly mediated by health literacy. Conclusions Results are important to understand the health disparities in connection to occupational situation, health literacy, and health. As a mean for health promotion, interventions to improve health literacy should be planned for groups receiving public benefits and when health information is delivered for these groups the level of health literacy should be considered. Key messages Association between employment status and health were partly mediated by health literacy. Interventions to improve health literacy should be planned for groups receiving public benefits.