• David H Howard, Tetine Sentell, and Julie A Gazmararian.
• Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA. david.howard@emory.edu
• J Gen Intern Med. 2006 Aug 1; 21 (8): 857861857-61.

BackgroundDifferences in health literacy levels by race and education are widely hypothesized to contribute to health disparities, but there is little direct evidence.ObjectiveTo examine the extent to which low health literacy exacerbates differences between racial and socioeconomic groups in terms of health status and receipt of vaccinations.DesignRetrospective cohort study. PARTICIPANTS (OR PATIENTS OR SUBJECTS): Three thousand two hundred and sixty noninstitutionalized elderly persons enrolling in a Medicare managed care plan in 1997 in Cleveland, OH; Houston, TX; South Florida; and Tampa, FL.MeasurementsDependent variables were physical health SF-12 score, mental health SF-12 score, self-reported health status, receipt of influenza vaccine, and receipt of pneumococcal vaccine. Independent variables included health literacy, educational attainment, race, income, age, sex, chronic health conditions, and smoking status.ResultsAfter adjusting for demographic and health-related variables, individuals without a high school education had worse physical and mental health and worse self-reported health status than those with a high school degree. Accounting for health literacy reduced these differences by 22% to 41%. Black individuals had worse self-reported health status and lower influenza and pneumococcal vaccination rates. Accounting for health literacy reduced the observed difference in self-reported health by 25% but did not affect differences in vaccination rates.ConclusionsWe found that health literacy explained a small to moderate fraction of the differences in health status and, to a lesser degree, receipt of vaccinations that would normally be attributed to educational attainment and/or race if literacy was not considered.

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