Health literacy and health outcomes in chronic obstructive pulmonary disease.
BACKGROUND
There is little information worldwide about the impact of health literacy (HL) on clinical outcomes of COPD. Our aim was to quantify inadequate HL in Spain, as measured by the Short Assessment of Health Literacy for Spanish Adults questionnaire, and to examine the associations between HL and both COPD outcomes and health status.


METHODS
296 COPD patients of 68(SD = 9) years and a FEV1%predicted of 53%(SD = 18%) were enrolled and followed-up for one year. 59% showed "inadequate" HL.


RESULTS
Individuals with inadequate HL were older (70[SD = 9] vs 65[SD = 8] years; p < 0.001) and had less knowledge of their disease, as measured by the low HL-COPD questionnaire, (6.9[SD = 2.3] vs 7.5[SD = 1.9]; p < 0.001). While their lung function was no different, they reported significant differences in mMRC (1.6[SD = 1] vs 1.4[SD = 1]; p < 0.001), CAT (19.2[SD = 8.1] vs 18.3[SD = 7.5]; p = 0.049), and EQ-5 (3.1[SD = 2.2] vs 2.3[SD = 1.9]; p < 0.00). Those with inadequate HL had also higher risk of having ≥2 comorbidities (OR = 1.87; 95%CI = 1.14-3.08), need of assistance (OR = 2.5; 95%CI = 1.5-4.2), anxiety/depression (OR = 1.9; 95%CI = 1.2-3.0), admissions or visits to the emergency department (OR = 1.70; 95%CI = 1.1-2.7), and all-cause deaths in the following year (3.8% (SE = 1.1%) vs 0%; p = 0.051).


CONCLUSIONS
Inadequate HL is prevalent among COPD patients and it is related to health status and relevant clinical outcomes of the disease. HL needs to be considered when planning the care for COPD patients.
['Puente-Maestu|Luis|L|', 'Calle|Myriam|M|', 'Rodríguez-Hermosa|Juan Luis|JL|', 'Campuzano|Anna|A|', 'de Miguel Díez|Javier|J|', 'Álvarez-Sala|Jose Luis|JL|', 'Puente-Andues|Luis|L|', 'Pérez-Gutiérrez|Maria Joselín|MJ|', 'Lee|Shoou-Yih D|SY|']
D000203:Activities of Daily Living D000368:Aged D015897:Comorbidity D003430:Cross-Sectional Studies D051341:Dependent Ambulation D003863:Depression D004636:Emergency Service, Hospital D005260:Female D005541:Forced Expiratory Volume D007722:Health Knowledge, Attitudes, Practice D057220:Health Literacy D006304:Health Status D006760:Hospitalization D006801:Humans D008297:Male D008875:Middle Aged D009026:Mortality D017063:Outcome Assessment, Health Care D029424:Pulmonary Disease, Chronic Obstructive D011788:Quality of Life D012129:Respiratory Function Tests D013030:Spain D011795:Surveys and Questionnaires
Health outcomes COPD Health status Daily living activities Dependence Utility Utilization