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Limited literacy and mortality in the elderly

The health, aging, and body composition study

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Abstract

BACKGROUND: While limited literacy is common and its prevalence increases with age, no prospective study has assessed whether limited literacy is associated with mortality in older adults.

OBJECTIVE: To assess the association of limited literacy with mortality.

DESIGN AND SETTING: Five-year prospective study from 1999 to 2004 of community-dwelling elders from Memphis, TN, and Pittsburgh, PA, who were from the Health, Aging, and Body Composition study. Subjects’ literacy was assessed with the Rapid Estimate of Adult Literacy in Medicine. Scores were categorzied into limited (0 to 8th grade reading level) or adequate literacy (≥9th grade reading level).

PARTICIPANTS: Two thousand five hundred and twelve black and white elders without baseline functional difficulties or dementia.

MEASUREMENTS: Time to death.

RESULTS: Participants’ mean age was 75.6 years, 48% were male, 38% were black, and 24% had limited literacy; the median follow-up time was 4.2 years. Compared with those with adequate literacy, those with limited literacy had a higher risk of death (19.7% vs 10.6%) with a hazard ratio (HR) of 2.03 (95% confidence intervals [CI], 1.62 to 2.55). After adjusting for demographics and socioeconomic status, co-morbid conditions, self-rated health status, health-related behaviors, health care access measures, and psychosocial status, limited literacy remained independently associated with mortality (HR 1.75; 95% CI, 1.27 to 2.41).

CONCLUSIONS: Limited literacy is independently associated with a nearly 2-fold increase in mortality in the elderly. Given the growth of the aging population and the prevalence of chronic diseases, the mechanisms by which limited literacy is associated with mortality in the elderly warrant further investigation.

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Author information

Authors and Affiliations

  1. San Francisco VAMC, University of California, 4150 Clement Street, Box 181G, 94121, San Francisco, CA

    Rebecca L. Sudore MD, Kristine Yaffe MD, Kala M. Mehta DSc, Susan M. Rubin MPH, Hilsa N. Ayonayon PhD & Dean Schillinger MD

  2. University of Tennessee, Memphis, TN, USA

    Suzanne Satterfield MD

  3. Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD, USA

    Tamara B. Harris MD

  4. Clinical Research Branch, National Institute on Aging, Baltimore, MD, USA

    Eleanor M. Simonsick PhD & Caterina Rosano MD

  5. University of Pittsburgh, Pittsburgh, PA, USA

    Anne B. Newman MD

  6. Kent State University, Kent, OH, USA

    Ronica Rooks PhD

Authors
  1. Rebecca L. Sudore MD
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  2. Kristine Yaffe MD
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  12. Dean Schillinger MD
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Corresponding author

Correspondence to Rebecca L. Sudore MD.

Additional information

This study was supported by the NIH grants NIA N01-AG-6-2101, N01-AG-6-2103, and N01-AG-6-2106. Dr. Sudore was supported by the NIH Research Training in Geriatric Medicine Grant AG000212 and by the Pfizer Fellowship in Clear Health Communication. Dr. Schillinger was supported by an NIH Mentored Clinical Scientist Award K-23 RR 16539-03.

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Sudore, R.L., Yaffe, K., Satterfield, S. et al. Limited literacy and mortality in the elderly. J GEN INTERN MED 21, 806–812 (2006). https://doi.org/10.1111/j.1525-1497.2006.00539.x

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