Friday, December 1, 2023
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While 36% of American adults overall have limited health literacy, the rate is considerably higher in certain demographic subgroups. Most notable is the rate of limited health literacy among people over 65 years old, with 59% of such individuals in the NAAL survey scoring at the basic or below-basic levels -- more than in any other age group (Figure 2). Other data corroborate the high rate of limited health literacy among older adults, including affluent elders. [6,7]
Figure 2. Health literacy skills of American adults in various age groups. From: Kutner M, Greenberg E, Jin Y, Paulsen C. The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). Washington, DC: National Center for Education Statistics, US Department of Education; 2006.
Certain ethnic/racial groups also have high rates of limited health literacy, with 66% of Hispanics and 58% of African Americans scoring in the basic or below-basic levels (Figure 3). This finding might reinforce a stereotype that individuals with limited literacy skills are mostly minority group members; in fact, it is true that minority populations do have a disproportionately high rate of limited literacy. But it is also important to emphasize that racial/ethnic risk factors do not reliably predict whether a specific individual has adequate or limited health literacy. Indeed, the most frequent demographic profile of an individual with limited health literacy in the United States is that of a white, native-born American. [8]
Figure 3. Health literacy skills of American adults in different ethnic/racial groups. From: Kutner M, Greenberg E, Jin Y, Paulsen C. The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). Washington, DC: National Center for Education Statistics, US Department of Education; 2006.
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Copyright 2007: American Medical Association and American Medical Association Foundation
Failure to complete high school is a strong risk factor for limited general and health literacy, with more than 8 of 10 such individuals having basic or below-basic skills. Completion of high school, however, does not assure good literacy skills; educational attainment only measures the number of years that an individual attended school, not what the person learned in school.
It is often noted that reading levels frequently lag several years behind education levels (ie, someone with a 10th-grade education might read at the 7th- or 8th-grade level or lower). Furthermore, approximately one quarter of individuals in national literacy surveys who score at the lowest reading levels, and thus have markedly deficient literacy skills, are high school graduates [9]; and 17% of NAAL participants who completed a college education had general literacy skills at the basic or below-basic levels. [10]
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Republished with permission of Terry C. Davis, PhD.
In summary, many clinicians believe they can use a patient's education level as a proxy for literacy skills. The fact is, however, that education level does not reliably predict literacy or a person's ability to understand medical information.
Language is another important predictor of limited health literacy. NAAL data show that individuals who recently immigrated to the United States from non-English-speaking countries have higher rates of low literacy. Similarly, people born or raised in the United States but whose first language was not English also have a higher rate of limited health literacy. Studies show that even when such individuals say they speak, read, and understand English well, formal assessments reveal that between a quarter and a third actually do not. [11]
Other important demographic risk factors for limited health literacy include a lack of health insurance or enrollment in Medicare or Medicaid (Figure 4). Limited literacy is also common among prisoners, the homeless, those with serious mental illnesses, and new military recruits. [12-15]
Figure 4. Health literacy skills of American adults with different types of health insurance. From: Kutner M, Greenberg E, Jin Y, Paulsen C. The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). Washington, DC: National Center for Education Statistics, US Department of Education; 2006.
However, it is essential to recognize that even individuals in the highest socioeconomic groups can have limited health literacy skills. In fact, Fortune magazine recently reported on billionaire executives who had limited literacy. [16]
