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. 2020 Jan 7:14:1-11.
doi: 10.2147/PPA.S211784. eCollection 2020.

Effects of Estimated Community-Level Health Literacy on Treatment Initiation and Preventive Care Among Older Adults with Newly Diagnosed Diabetes

Gang Fang  1 , Stacy Cooper Bailey  2 , Izabela E Annis  1 , Michael K Paasche-Orlow  3 , Michael S Wolf  2 , Laurie T Martin  4 , Michael Emch  5 , M Alan Brookhart  6 , Karen B Farris  7
Affiliations

Effects of Estimated Community-Level Health Literacy on Treatment Initiation and Preventive Care Among Older Adults with Newly Diagnosed Diabetes

Gang Fang et al. Patient Prefer Adherence. .

Abstract

Purpose: Individual measures of health literacy are not feasible for administration on a large scale, yet estimates of community-level health literacy in the US recently became available. We sought to investigate whether community-level health literacy estimates are associated with the initiation of oral antihyperglycemic agents (OHA) and the use of standard preventive care services among older adults with newly diagnosed diabetes.

Patients and methods: We conducted a retrospective cohort study of 169,758 patients, ≥65 years old with hypertension and newly diagnosed type 2 diabetes using 2007-2011 data from the Center for Medicare and Medicaid Services Chronic Conditions Warehouse. We examined the relationship between community-level health literacy estimates and initiation of OHA, receipt of flu shots, eye exams, Hemoglobin A1c tests, and lipid tests within 12 months post diabetes diagnosis.

Results: Patients living in communities with above basic health literacy (vs. basic/below basic) were 15% more likely to initiate OHA (Hazard Ratio=1.15; 95% CI 1.12 to 1.18). After classifying the health literacy distribution as quintiles, the analysis revealed a dose-response relationship with OHA initiation that plateaued at the third and fourth quintiles and declined at the fifth quintile. Individuals residing in communities with higher health literacy were more likely to participate in preventive care services (relative risk ranged from 1.09 for lipid test [95% CI 1.07-1.11] to 1.43 for flu shot [95% CI 1.41-1.46]).

Conclusion: Community-level health literacy estimates were associated with the initiation of OHA and uptake of standard preventive care services in older adults. Community-level health literacy may help to inform targeted diabetes education and support efforts.

Keywords: adherence; diabetes mellitus; health literacy; preventive care.

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Conflict of interest statement

MSW has predoctoral student fellowships funded through Abbvie and Amgen. He has also received grant support from Merck, Sharp & and Dohme, Eli Lilly, UnitedHealthcare, Amgen and AbbVie. MSW has also served as a consultant or advisory board member to Luto UK, Vivus, AbbVie, Abbott Labs, Merck, Pfizer, CVS/Caremark, AB Imbev Foundation, Deborah Adler and OptumHealth. SCB has served as a consultant for Merck, Sharp and Dohme, Pfizer, and Luto UK and has received grant funding via her institution from Eli Lilly and Merck, Sharp and Dohme. SCB has also received personal fees from Northwestern University/Gordon and Betty Moore Foundation. MKP-O has served as a consultant for Communicate Health, Engineered Care, Nous, and Merck. He has also received grant support from OptumHealth. MAB has received grant support from Amgen and AstraZeneca and served as a scientific advisor for RxAnte, Pfizer, Merck, and Amgen. KBF consults with QuiO, a technology adherence company and receives hourly compensation. All other authors have no conflicts of interest to report.

Figures

Figure 1
Figure 1
Map of estimated community-level health literacy in the US. Note: Reproduced from Health Literacy Data Map. US Health Literacy Data Map. Chapel Hill: University of North Carolina at Chapel Hill, 2019. Available from: http://healthliteracymap.unc.edu/.
Figure 2
Figure 2
Distribution of mean community health literacy estimates in a cohort of hypertensive Medicare patients, newly diagnosed with diabetes.
Figure 3
Figure 3
Associations between community health literacy levels and initiation of oral antihyperglycemic agents after new type 2 diabetes diagnosis. Notes: Reference groups: Community health literacy at basic/below level; Q1 (lowest) level of community health literacy in quintiles. Based on the 2003 National Assessment of Adult Literacy (NAAL) categorization of health literacy proficiencies (8) into two categories: “above basic” (score >225) vs. “basic/below basic” (score ≤225). Abbreviations: HL, health literacy; Q, quintile.
Figure 4
Figure 4
(A–D) Associations between community health literacy levels and preventive care services within 12 months post new type 2 diabetes diagnosis.
See this image and copyright information in PMC

References

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    1. Centers for Disease Control and Prevention. 2014. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: US Department of Health and Human Services.
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    1. Institute of Medicine. Health Literacy: A Prescription to End Confusion. Washington, DC: National Academies Press; 2014.

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