The relationship of health literacy to diabetes status differs by sex in older adults

Michael Quartuccio, Eleanor Marie Simonsick, Susan Langan, Tamara Harris, Rebecca L. Sudore, Roland J Thorpe, Caterina Rosano, Felicia Hill-Briggs, Sherita Hill Golden, Rita R. Kalyani

Research output: Contribution to journalArticle

Abstract

Objective: Lower health literacy is associated with higher rates of mortality and chronic disease. It remains unclear whether health literacy is associated with diabetes and/or hyperglycemia in older adults, and if this relationship differs by sex. Research design and methods: We performed a cross-sectional analysis of 2510 older adults in the Health, Aging and Body Composition (Health ABC) Study who had both a Rapid Estimate of Adult Literacy in Medicine (REALM) measurement and diabetes status available. Sex-stratified logistic regression models were used to analyze the relationship of health literacy categories (low, medium, and high) to diabetes status, adjusting for key covariates. Secondary analyses examined the relationship of health literacy to glycemic markers (A1C, fasting blood glucose). Results: Among participants in the Health ABC cohort, 429 had diabetes. Mean age was 76. years old and 45% were female. Men with diabetes more commonly had low health literacy levels than men without diabetes (10.1% versus 9.3%, p = 0.02). Similar results were seen among women (14.7% versus 6.1%, p. <. 0.01). In a model adjusting for age, race, income, education, BMI, smoking, and alcohol use, women with low versus high health literacy had a two-fold higher likelihood of diabetes (OR = 2.2; 95% CI 1.1-4.3). No significant relationship was observed in men. Progressively lower categories of health literacy were associated with higher age-adjusted mean A1C and fasting blood glucose levels in women (both p for trend <. 0.01) but not men. Conclusions: In this large, ethnically diverse sample of community-dwelling older adults, lower health literacy level is related to a greater likelihood of diabetes and higher A1C and fasting blood glucose levels in women-but not in men-after adjusting for age, race, and other demographic and lifestyle factors. Future studies are needed to assess mechanisms underlying this relationship and if interventions to improve health literacy are effective in reducing the burden of diabetes, particularly in women.

Original languageEnglish (US)
JournalJournal of Diabetes and its Complications
DOIs
StateAccepted/In press - Jan 1 2017

Fingerprint

Health Literacy
Blood Glucose
Fasting
Body Composition
Logistic Models
Independent Living
Health
Hyperglycemia
Life Style
Chronic Disease
Research Design
Cross-Sectional Studies
Smoking
Alcohols
Medicine
Demography
Education

Keywords

  • Diabetes mellitus
  • Health literacy
  • Hyperglycemia
  • Older adults
  • Sex differences

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

The relationship of health literacy to diabetes status differs by sex in older adults. / Quartuccio, Michael; Simonsick, Eleanor Marie; Langan, Susan; Harris, Tamara; Sudore, Rebecca L.; Thorpe, Roland J; Rosano, Caterina; Hill-Briggs, Felicia; Golden, Sherita Hill; Kalyani, Rita R.

In: Journal of Diabetes and its Complications, 01.01.2017.

Research output: Contribution to journalArticle

@article{bc4f6dc2f4cf4cfc835940da0a90506e,
title = "The relationship of health literacy to diabetes status differs by sex in older adults",
abstract = "Objective: Lower health literacy is associated with higher rates of mortality and chronic disease. It remains unclear whether health literacy is associated with diabetes and/or hyperglycemia in older adults, and if this relationship differs by sex. Research design and methods: We performed a cross-sectional analysis of 2510 older adults in the Health, Aging and Body Composition (Health ABC) Study who had both a Rapid Estimate of Adult Literacy in Medicine (REALM) measurement and diabetes status available. Sex-stratified logistic regression models were used to analyze the relationship of health literacy categories (low, medium, and high) to diabetes status, adjusting for key covariates. Secondary analyses examined the relationship of health literacy to glycemic markers (A1C, fasting blood glucose). Results: Among participants in the Health ABC cohort, 429 had diabetes. Mean age was 76. years old and 45{\%} were female. Men with diabetes more commonly had low health literacy levels than men without diabetes (10.1{\%} versus 9.3{\%}, p = 0.02). Similar results were seen among women (14.7{\%} versus 6.1{\%}, p. <. 0.01). In a model adjusting for age, race, income, education, BMI, smoking, and alcohol use, women with low versus high health literacy had a two-fold higher likelihood of diabetes (OR = 2.2; 95{\%} CI 1.1-4.3). No significant relationship was observed in men. Progressively lower categories of health literacy were associated with higher age-adjusted mean A1C and fasting blood glucose levels in women (both p for trend <. 0.01) but not men. Conclusions: In this large, ethnically diverse sample of community-dwelling older adults, lower health literacy level is related to a greater likelihood of diabetes and higher A1C and fasting blood glucose levels in women-but not in men-after adjusting for age, race, and other demographic and lifestyle factors. Future studies are needed to assess mechanisms underlying this relationship and if interventions to improve health literacy are effective in reducing the burden of diabetes, particularly in women.",
keywords = "Diabetes mellitus, Health literacy, Hyperglycemia, Older adults, Sex differences",
author = "Michael Quartuccio and Simonsick, {Eleanor Marie} and Susan Langan and Tamara Harris and Sudore, {Rebecca L.} and Thorpe, {Roland J} and Caterina Rosano and Felicia Hill-Briggs and Golden, {Sherita Hill} and Kalyani, {Rita R.}",
year = "2017",
month = "1",
day = "1",
doi = "10.1016/j.jdiacomp.2017.10.012",
language = "English (US)",
journal = "Journal of Diabetes and its Complications",
issn = "1056-8727",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - The relationship of health literacy to diabetes status differs by sex in older adults

AU - Quartuccio, Michael

AU - Simonsick, Eleanor Marie

AU - Langan, Susan

AU - Harris, Tamara

AU - Sudore, Rebecca L.

AU - Thorpe, Roland J

AU - Rosano, Caterina

AU - Hill-Briggs, Felicia

AU - Golden, Sherita Hill

AU - Kalyani, Rita R.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Objective: Lower health literacy is associated with higher rates of mortality and chronic disease. It remains unclear whether health literacy is associated with diabetes and/or hyperglycemia in older adults, and if this relationship differs by sex. Research design and methods: We performed a cross-sectional analysis of 2510 older adults in the Health, Aging and Body Composition (Health ABC) Study who had both a Rapid Estimate of Adult Literacy in Medicine (REALM) measurement and diabetes status available. Sex-stratified logistic regression models were used to analyze the relationship of health literacy categories (low, medium, and high) to diabetes status, adjusting for key covariates. Secondary analyses examined the relationship of health literacy to glycemic markers (A1C, fasting blood glucose). Results: Among participants in the Health ABC cohort, 429 had diabetes. Mean age was 76. years old and 45% were female. Men with diabetes more commonly had low health literacy levels than men without diabetes (10.1% versus 9.3%, p = 0.02). Similar results were seen among women (14.7% versus 6.1%, p. <. 0.01). In a model adjusting for age, race, income, education, BMI, smoking, and alcohol use, women with low versus high health literacy had a two-fold higher likelihood of diabetes (OR = 2.2; 95% CI 1.1-4.3). No significant relationship was observed in men. Progressively lower categories of health literacy were associated with higher age-adjusted mean A1C and fasting blood glucose levels in women (both p for trend <. 0.01) but not men. Conclusions: In this large, ethnically diverse sample of community-dwelling older adults, lower health literacy level is related to a greater likelihood of diabetes and higher A1C and fasting blood glucose levels in women-but not in men-after adjusting for age, race, and other demographic and lifestyle factors. Future studies are needed to assess mechanisms underlying this relationship and if interventions to improve health literacy are effective in reducing the burden of diabetes, particularly in women.

AB - Objective: Lower health literacy is associated with higher rates of mortality and chronic disease. It remains unclear whether health literacy is associated with diabetes and/or hyperglycemia in older adults, and if this relationship differs by sex. Research design and methods: We performed a cross-sectional analysis of 2510 older adults in the Health, Aging and Body Composition (Health ABC) Study who had both a Rapid Estimate of Adult Literacy in Medicine (REALM) measurement and diabetes status available. Sex-stratified logistic regression models were used to analyze the relationship of health literacy categories (low, medium, and high) to diabetes status, adjusting for key covariates. Secondary analyses examined the relationship of health literacy to glycemic markers (A1C, fasting blood glucose). Results: Among participants in the Health ABC cohort, 429 had diabetes. Mean age was 76. years old and 45% were female. Men with diabetes more commonly had low health literacy levels than men without diabetes (10.1% versus 9.3%, p = 0.02). Similar results were seen among women (14.7% versus 6.1%, p. <. 0.01). In a model adjusting for age, race, income, education, BMI, smoking, and alcohol use, women with low versus high health literacy had a two-fold higher likelihood of diabetes (OR = 2.2; 95% CI 1.1-4.3). No significant relationship was observed in men. Progressively lower categories of health literacy were associated with higher age-adjusted mean A1C and fasting blood glucose levels in women (both p for trend <. 0.01) but not men. Conclusions: In this large, ethnically diverse sample of community-dwelling older adults, lower health literacy level is related to a greater likelihood of diabetes and higher A1C and fasting blood glucose levels in women-but not in men-after adjusting for age, race, and other demographic and lifestyle factors. Future studies are needed to assess mechanisms underlying this relationship and if interventions to improve health literacy are effective in reducing the burden of diabetes, particularly in women.

KW - Diabetes mellitus

KW - Health literacy

KW - Hyperglycemia

KW - Older adults

KW - Sex differences

UR - http://www.scopus.com/inward/record.url?scp=85036583342&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85036583342&partnerID=8YFLogxK

U2 - 10.1016/j.jdiacomp.2017.10.012

DO - 10.1016/j.jdiacomp.2017.10.012

M3 - Article

C2 - 29198996

AN - SCOPUS:85036583342

JO - Journal of Diabetes and its Complications

JF - Journal of Diabetes and its Complications

SN - 1056-8727

ER -