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Outcomes/Effectiveness Research

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Low literacy is associated with several adverse health outcomes

Low literacy is common in the United States, with 90 million adults unable to understand information from complex texts or perform calculations requiring two or more sequential operations. Low literacy interferes with functioning in society and achieving goals, and it also is linked with poorer health outcomes.

Researchers at the RTI International-University of North Carolina Evidence-based Practice Center (EPC), which is supported by the Agency for Healthcare Research and Quality (contract 290-02-0016) and led by Kathleen N. Lohr, Ph.D., conducted a review of the published evidence from 1980 to 2003 on literacy and health outcomes and produced an evidence report on the topic.

A total of 73 articles met inclusion criteria, and 44 of those addressed the questions in the evidence report. Patients with low literacy had poorer health outcomes, including health knowledge, intermediate disease markers, measures of morbidity, general health status, and use of health resources. Patients with low literacy were generally 1.5 to 3 times as likely as more literate patients to experience a given poor outcome. For instance, Medicare enrollees with lower literacy were nearly twice as likely not to have had a Pap smear or mammogram in the previous 2 years as patients with higher literacy, after controlling for age, race, and other factors.

Low-literacy patients with diabetes were twice as likely to have poor control of type 2 diabetes as more literate diabetes patients. Also, men with poorer reading ability were more likely to be diagnosed with late-stage prostate cancer than those with better reading ability. Finally, low literacy level was significantly associated with increased risk of hospitalization. The average quality of the studies reviewed was fair to good.

See "Literacy and health outcomes: A systematic review of the literature," by Darren A. DeWalt, M.D., M.P.H., Nancy D. Berkman, Ph.D., Stacey Sheridan, M.D., M.P.H., and others, in the December 2004 Journal of General Internal Medicine 19, pp. 1228-1239.

Editor's Note: The evidence report and a summary, Literacy and Health Outcomes, Evidence Report/Technology Assessment No. 87, are available online from the AHRQ Web site at www.ahrq.gov/clinic/tp/littp.htm. Print copies (04-E007-1, summary, 04-E007-2, full report) are available from the AHRQ Publications Clearinghouse.

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