Limited health literacy is associated with low glomerular filtration in the Chronic Renal Insufficiency Cohort (CRIC) study

Abstract

Background: Low health literacy in the general population is associated with increased risk of death and hospitalization. The evaluation of health literacy in individuals with predialysis chronic kidney disease (CKD) is limited. Methods: We conducted a cross-sectional study to evaluate the associations of limited health literacy with kidney function and cardiovascular disease (CVD) risk factors in 2,340 non-Hispanic (NH) Whites and Blacks aged 21 – 74 years with mild-to-moderate CKD. Limited health literacy was defined as a Short Test of Functional Health Literacy in Adults (STOFHLA) score ≤ 22. Outcomes evaluated included estimated glomerular filtration rate (eGFR), 24-hour urine protein excretion, and CVD risk factors. Results: The prevalence of limited health literacy was 28% in NH-Blacks and 5% in NH-Whites. Compared with participants with adequate health literacy, those with limited health literacy were more likely to have lower eGFR (34 vs. 42 mL/min/1.73 m2); higher urine protein/24-hours (0.31 vs. 0.15 g); and higher self-reported CVD (61 vs. 37%); and were less likely to have BP < 130/80 mmHg (51 vs. 58%); p ≤ 0.01 for each comparison. After adjustment, limited health literacy was associated with self-reported CVD (OR 1.51, 95% CI 1.13 – 2.03) and lower eGFR (β –2.47, p = 0.03). Conclusion: In this CKD cohort, limited health literacy was highly prevalent, especially among NH-Blacks, and it was associated with lower eGFR and a less favorable CVD risk factor profile. Further studies are needed to better understand these associations and inform the development of health literacy interventions among individuals with CKD.

La enfermedad renal crónica en Colombia: necesidades en salud y respuesta del Sistema General de Seguridad Social en Salud

“…Adicionalmente, se encontraron diferencias en la calidad de la atención en las poblaciones del régimen subsidiado (19). Algunas investigaciones en el ámbito mundial refuerzan este hallazgo, en la medida en que han encontrado asociación entre la erc y el bajo nivel de información en salud (39).…”

Improving Care of Patients With CKD: The 2015 National Kidney Foundation Presidential Address

“…22 Approximately 20% to 30% of patients with CKD have limited health literacy, a level that corresponds roughly to a 5th to 6th grade reading level. [23][24][25] In the United States, limited health care literacy is 5 to 6 times more common among African Americans than whites, and in cross-sectional studies, limited health literacy is more prevalent among individuals with lower eGFRs. Among patients treated with hemodialysis, low health literacy is associated with increased mortality.…”

Health Literacy Mediates Racial Disparities in Cardiopulmonary Resuscitation Knowledge among Chronic Kidney Disease Patients

“…10–13 Limited health literacy impedes an individual’s capacity to understand basic information to make informed medical decisions and approximately 28–32% of patients with CKD are afflicted. 14–16 Patients’ understanding of the risks and benefits of CPR has been shown to be associated with subsequent treatment preferences and more recent studies of general medicine patients have focused on the effect of health literacy on racial disparities in preferences for EOL care and advance care planning. 11, 17–21 Still, the role of race and health literacy in EOL treatment knowledge in the CKD population has not been fully explored.…”