TY - JOUR
T1 - The relationship of health literacy to diabetes status differs by sex in older adults
AU - Quartuccio, Michael
AU - Simonsick, Eleanor M.
AU - Langan, Susan
AU - Harris, Tamara
AU - Sudore, Rebecca L.
AU - Thorpe, Roland
AU - Rosano, Caterina
AU - Hill-Briggs, Felicia
AU - Golden, Sherita
AU - Kalyani, Rita R.
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2018/4
Y1 - 2018/4
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
SN - 1056-8727
VL - 32
SP - 368
EP - 372
JO - Journal of Diabetes and its Complications
JF - Journal of Diabetes and its Complications
IS - 4
ER -