Abstract

Background: Low health literacy in the general population is associated with increased risk of death and hospitalization. The evaluation of health literacy in individuals with predialysis chronic kidney disease (CKD) is limited. Methods: We conducted a cross-sectional study to evaluate the associations of limited health literacy with kidney function and cardiovascular disease (CVD) risk factors in 2,340 non-Hispanic (NH) Whites and Blacks aged 21 – 74 years with mild-to-moderate CKD. Limited health literacy was defined as a Short Test of Functional Health Literacy in Adults (STOFHLA) score ≤ 22. Outcomes evaluated included estimated glomerular filtration rate (eGFR), 24-hour urine protein excretion, and CVD risk factors. Results: The prevalence of limited health literacy was 28% in NH-Blacks and 5% in NH-Whites. Compared with participants with adequate health literacy, those with limited health literacy were more likely to have lower eGFR (34 vs. 42 mL/min/1.73 m²); higher urine protein/24-hours (0.31 vs. 0.15 g); and higher self-reported CVD (61 vs. 37%); and were less likely to have BP < 130/80 mmHg (51 vs. 58%); p ≤ 0.01 for each comparison. After adjustment, limited health literacy was associated with self-reported CVD (OR 1.51, 95% CI 1.13 – 2.03) and lower eGFR (β –2.47, p = 0.03). Conclusion: In this CKD cohort, limited health literacy was highly prevalent, especially among NH-Blacks, and it was associated with lower eGFR and a less favorable CVD risk factor profile. Further studies are needed to better understand these associations and inform the development of health literacy interventions among individuals with CKD.

Author Details

Authors

• Ana C. Ricardo¹
• Wei Yang²
• Claudia M. Lora¹
• Elisa J. Gordon³
• Clarissa J. Diamantidis⁴
• Virginia Ford²
• John W. Kusek⁵
• Amada Lopez¹
• Eva Lustigova⁶
• Lisa Nessel²
• Sylvia E. Rosas⁷
• Susan Steigerwalt⁸
• Jacqueline Theurer⁹
• Xiaoming Zhang²
• Michael J. Fischer¹,¹⁰
• James P. Lash¹
• on behalf of the CRIC Investigators

Departments

• ¹ Department of Medicine, University of Illinois at Chicago, Chicago, IL,
• ² Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PN,
• ³ Feinberg School of Medicine, Northwestern University, Chicago, IL,
• ⁴ University of Maryland School of Medicine, Baltimore, MD,
• ⁵ National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD,
• ⁶ Tulane University, New Orleans, LA,
• ⁷ Department of Medicine, University of Pennsylvania/Philadelphia VA Medical Center, Philadelphia, PN,
• ⁸ St. John’s Health System, Detroit, MI,
• ⁹ Division of Nephrology, Department of Medicine, MetroHealth Medical Center, Cleveland, OH, and
• ¹ 
• ⁰ Center for Management of Complex Chronic Care, Jesse Brown VA Medical Center, Chicago, IL, USA

Address

Ana C. Ricardo, MD, MPH
Section of Nephrology, University of Illinois at Chicago
820 South Wood Street, Room 470, Chicago, IL 60616, USA
Email: [email protected]

Citation