Limited literacy and mortality in the elderly: the health, aging, and body composition study

Topic: Risk, prevention and care in population studies

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 categorized into limited (0 to 8th grade reading level) or adequate literacy (> or = 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.

Key findings

• 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.
• 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.

Why it matters

This study found that older adults with limited literacy had a higher risk of death over five years, even after adjusting for many other factors. It concerns literacy and mortality generally and does not address treating, curing or preventing Alzheimer's disease.

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Study details

• Effect size19.7%; 10.6%; HR 1.75
• Evidence strengthLow

Read the original

• DOI: 10.1111/j.1525-1497.2006.00539.x
• PubMed: 16881938
• Original source →
• Free full text: Journal of General Internal Medicine →

Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).

@article{sudore2006-16881938,
  author  = {Sudore, R. L. and Yaffe, K. and Satterfield, S. and Harris, T. B. and Mehta, K. M. and Simonsick, E. M. and Newman, A. B. and Rosano, C. and others},
  title   = {{Limited literacy and mortality in the elderly: the health, aging, and body composition study}},
  journal = {Journal of general internal medicine},
  year    = {2006},
  doi     = {10.1111/j.1525-1497.2006.00539.x},
  pmid    = {16881938},
  url     = {https://doi.org/10.1111/j.1525-1497.2006.00539.x}
}

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