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August 2002, Vol 92, No. 8 | American Journal of Public Health 1278-1283
© 2002 American Public Health Association

RESEARCH AND PRACTICE

Functional Health Literacy and the Risk of Hospital Admission Among Medicare Managed Care Enrollees

David W. Baker, MD, MPH, Julie A. Gazmararian, PhD, MPH, Mark V. Williams, MD, Tracy Scott, PhD, Ruth M. Parker, MD, Diane Green, PhD, Junling Ren, MEd and Jennifer Peel, MPH

David W. Baker is with the Center for Health Care Research and Policy and the Department of Medicine, Case Western Reserve University at MetroHealth Medical Center; and the Department of Epidemiology–Biostatistics, Case Western Reserve University School of Medicine, Cleveland, Ohio. Julie A. Gazmararian, Tracy Scott, Diane Green, Junling Ren, and Jennifer Peel are with US Quality Algorithms Center for Health Care Research, Atlanta, Ga. Mark V. Williams and Ruth M. Parker are with the Department of Medicine, Emory University School of Medicine, Atlanta, Ga.

Correspondence: Requests for reprints should be sent to David W. Baker, MD, MPH, Northwestern University Medical School, Suite 200, 676 North St. Clair Street, Chicago, Illinois 60611 (e-mail: dwbaker{at}northwestern.edu).

Objectives. This study analyzed whether inadequate functional health literacy is an independent risk factor for hospital admission.

Methods. We studied a prospective cohort of 3260 Medicare managed care enrollees.

Results. Of the participants, 29.5% were hospitalized. The crude relative risk (RR) of hospitalization was higher for individuals with inadequate literacy (n = 800; RR = 1.43; 95% confidence interval [CI] = 1.24, 1.65) and marginal literacy (n = 366; RR = 1.33; 95% CI = 1.09, 1.61) than for those with adequate literacy (n = 2094). In multivariate analysis, the adjusted relative risk of hospital admission was 1.29 (95% CI = 1.07, 1.55) for individuals with inadequate literacy and 1.21 (95% CI = 0.97, 1.50) for those with marginal literacy.

Conclusions. Inadequate literacy was an independent risk factor for hospital admission among elderly managed care enrollees. (Am J Public Health. 2002;92:1278–1283)




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