Health Literacy Is an Independent Predictor of Cancer Patients' Hospitalizations

Abstract

Background: Lower levels of health literacy predict higher hospitalization rates. Hospitalization is expensive and many admissions are potentially avoidable. Research examining the relationship between health literacy and health outcomes for cancer patients is limited, and no published studies to date have focused on hospitalization and health literacy in cancer patients. Objective: This study examined the ability of health literacy to predict hospitalization of cancer patients. Methods: This secondary data analysis investigated the relationship between health literacy and hospitalization rates of adult cancer patients in the first 5 years after their diagnosis. The sample included a diverse selection of cancer diagnoses and all stages of cancer were represented. Health literacy was assessed using the Cancer Health Literacy Test 30 (CHLT-30), a psychometrically sound measure of health literacy validated in a cancer patient population. Health literacy's ability to predict the number of times hospitalized, total days spent hospitalized, and number of 30-day readmissions was examined using multivariate negative binomial multiple regression to control for the outcomes and potentially confounding variables. Key Results: When controlling for potentially confounding variables, a negative relationship was found between health literacy and the number of inpatient hospitalizations (β = −0.041, p = .009) and the total number of days spent hospitalized (β = −0.028, p = .023) independently, whereas the relationship between health literacy and the number of 30-day readmissions failed to reach significance (β = −0.002, p = .903). Conclusions: Patients with lower health literacy need additional assistance to avoid unplanned hospitalizations. [ Health Literacy Research and Practice . 2017;1(4):e153–e162.] Plain Language Summary: Results from this study found that as cancer patients' health literacy scores decreased, the number of times hospitalized and the total number of days spent in the hospital increased. This relationship was significant when controlling for diagnosis, stage at diagnosis, receipt of chemotherapy, number of comorbidities, death, education, and race. Cancer patients with low health literacy are at a higher risk of being hospitalized.

Health Literacy and Health Service Use in Germany

“…This is in line with findings from Belgium, which also show no relationship between HL and emergency consultations (Vandenbosch et al, 2016). However, our results contradict findings from Italy (Palumbo et al, 2016) and the U.S. (Berkman et al 2011; Cartwright et al, 2017; Griffey et al, 2014), which show an independent, direct relation between HL and emergency service and hospital use.…”

“…Patient studies in the U.S. indicate that HL is related to health service use, health status indicators, and health behavior. People with lower functional HL are less likely to use preventive services and more likely to use and repeatedly use emergency or hospital care (Berkman, Sheridan, Donahue, Halpern, & Crotty, 2011; Cartwright, Dumenci, Cassel, Thomson, & Matsuyama, 2017; Griffey, Kennedy, D'Agostino McGowan, Goodman, & Kaphingst, 2014; Michtell, Sadikova, Jack, & Paasche-Orlow, 2012; Scott, Gazmararian, Williams, & Baker, 2002).…”

Der Nationale Aktionsplan Gesundheitskompetenz – Notwendigkeit, Ziel und Inhalt

“…Bemerkenswert sind auch die Befunde zum Outcome von Health Literacy. Sie sprechen dafür, dass eine hohe Gesundheitskompetenz Hand in Hand mit einer höheren Teilnahme an gesundheitsförderlichen und präventiven Maßnahmen geht [5,6] und außerdem mit einem gesünderen Lebensstil, besserer Ernährung, höherer körperlicher Aktivität und geringerer Nutzung von Versorgungsangeboten wie Notfallambulanzen oder Arztpraxen korreliert [5,[7][8][9].…”

Association of health literacy and cognition levels with severity of adverse drug reactions in cancer patients: a South Asian experience

“…HL as an entity is more important in functioning as a patient with cancer because interactions with varied specialties for surgery, radiation, cycles of chemotherapy, and post-treatment care are complex [5]. Corroborating with this, Cartwright et al [6] also concluded in their study that HL is an independent predictor of hospital admissions in cancer patients. Another meta-analysis of Adverse Drug Reactions (ADRs) in hospitalized patients by Lazarou et al [7] found anti-cancer drugs to be the main contributor to deaths related to ADRs.…”