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Limited health literacy and adverse outcomes among kidney transplant candidates
Author(s) -
Warsame Fatima,
Haugen Christine E.,
Ying Hao,
GaronzikWang Jacqueline M.,
Desai Niraj M.,
Hall Rasheeda K.,
Kambhampati Rekha,
Crews Deidra C.,
Purnell Tanjala S.,
Segev Dorry L.,
McAdamsDeMarco Mara A.
Publication year - 2019
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.14994
Subject(s) - medicine , health literacy , hazard ratio , odds ratio , confidence interval , logistic regression , demography , comorbidity , literacy , gerontology , proportional hazards model , health care , sociology , economics , economic growth
More than one‐third of US adults have limited health literacy, putting them at risk of adverse clinical outcomes. We evaluated the prevalence of limited health literacy among 1578 adult kidney transplant (KT) candidates (May 2014‐November 2017) and examined its association with listing for transplant and waitlist mortality in this pilot study. Limited health literacy was assessed at KT evaluation by using a standard cutoff score ≤5 on the Brief Health Literacy Screen (score range 0‐12, lower scores indicate worse health literacy). We used logistic regression and adjusted Cox proportional hazards models to identify risk factors for limited health literacy and to quantify its association with listing and waitlist mortality. We found that 8.9% of candidates had limited health literacy; risk factors included less than college education (adjusted odds ratio [aOR] = 2.87, 95% confidence interval [CI]:1.86‐4.43), frailty (aOR = 1.85, 95% CI:1.22‐2.80), comorbidity (Charlson comorbidity index [1‐point increase] aOR = 1.12, 95% CI: 1.04‐1.20), and cognitive impairment (aOR = 3.45, 95% CI: 2.20‐5.41) after adjusting for age, sex, race, and income. Candidates with limited health literacy had a 30% (adjusted hazard ratio = 0.70, 95% CI: 0.54‐0.91) decreased likelihood of listing and a 2.42‐fold (95% CI: 1.16‐ to 5.05‐fold) increased risk of waitlist mortality. Limited health literacy may be a salient mechanism in access to KT; programs to aid candidates with limited health literacy may improve outcomes and reduce disparities.