Diabetes Numeracy

Abstract

OBJECTIVEUnderstanding the reasons and eliminating the pervasive health disparities in diabetes is a major research, clinical, and health policy goal. We examined whether health literacy, general numeracy, and diabetes-related numeracy explain the association between African American race and poor glycemic control (A1C) in patients with diabetes.RESEARCH DESIGN AND METHODSAdults with type 2 diabetes (n = 383) were enrolled in a cross-sectional study at primary care and diabetes clinics at three medical centers. Data collected included the following: self-reported race, health literacy, general numeracy, diabetes-related numeracy, A1C, and sociodemographic factors. A series of structural equation models were estimated to explore the interrelations between variables and test for mediation.RESULTSIn model 1, younger age (r = −0.21, P < 0.001), insulin use (r = 0.27, P < 0.001), greater years with diabetes (r = 0.16, P < 0.01), and African American race (r = 0.12, P < 0.01) were all associated with poorer glycemic control. In model 2, diabetes-related numeracy emerged as a strong predictor of A1C (r = −0.46, P < 0.001), reducing the association between African American and poor glycemic control to nonsignificance (r = 0.10, NS). In model 3, African American race and older age were associated with lower diabetes-related numeracy; younger age, insulin use, more years with diabetes, and lower diabetes-related numeracy were associated with poor glycemic control.CONCLUSIONSDiabetes-related numeracy reduced the explanatory power of African American race, such that low diabetes-related numeracy, not African American race, was significantly related to poor glycemic control. Interventions that address numeracy could help to reduce racial disparities in diabetes.

Prevalence and Demographic and Clinical Associations of Health Literacy in Patients on Maintenance Hemodialysis

“…Nonetheless, African-Americans with chronic kidney disease are less likely to be seen by a nephrologist, more likely to progress to ESRD, and less likely to be listed for or receive a renal transplant (48). Moreover, there is evidence from studies in patients with other chronic diseases that health literacy mediates racial disparities in health outcomes (49,50). This suggests that efforts to improve health literacy among racial minorities and sociodemographically disadvantaged patients, including veterans, with chronic renal disease and ESRD may be a means to reduce health disparities and improve outcomes.…”

Promoting Health Literacy Research to Reduce Health Disparities

“…For example, in an adjusted analysis that excluded health literacy, African Americans were 2.4 times more likely to be non-adherent to their HIV medication regimen than whites (95% confidence interval [CI] ¼ 1.14-5.08). When health literacy was included in the final model adjusting for relevant covariates, the effect estimates of race Promoting Health Literacy Researchdiminished to non-significance and health literacy remained a significant independent predictor of non-adherence (adjusted odds ratio [AOR] ¼ 2.12, 95% CI ¼ 1.93-2.32) (Osborn, Paasche-Orlow, Davis, & Wolf, 2007). In another study, patients were asked their preferences regarding end-of-life care if they would develop advanced dementia.…”

“…The consequences of early failures in education have more recently been linked to problems in healthcare. Research has begun to emerge showing how a health literacy skill set is linked to a range of health outcomes, and evidence has also emerged demonstrating how deficits in these skills possibly explain certain disparities (Bennett, 2009;Osborn, Cavanaugh, Wallston, White, & Rothman, 2009;Osborn, Paasche-Orlow, Davis, & Wolf, 2007;Sentell, 2006;Waldrop-Valverde, 2010;Wolf, 2006).…”

Introduction: Child Health Disparities and Health Literacy

“…7 A number of studies have suggested that health literacy may be an important factor in mediating health disparities. [8][9][10] Health equity is a universal principle in the American Academy of Pediatrics agenda for children. The Academic Pediatric Association's vision and strategic plan emphasize an "equitable children's health agenda."…”