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Multivariable regression analysis was then undertaken to identify those factors that remained significant when all those identified in the univariable analysis were considered together.
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Analyses were performed using Stata V. Cohort characteristics are detailed elsewhere. Exploring indicators of low health literacy in a cohort with symptomatic coronary heart disease. The results of the univariable and multivariable analyses are shown in table 1.
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Of the cohort participants The non-responders were excluded from the analyses. Non-responders lived in more socioeconomically deprived areas and had received fewer years of education than those who completed the REALM. There was no difference in ethnicity responders vs non-responders. For the multivariable analysis 28 patients could not be included due to missing predictor variable data, leaving a total sample of Exploratory univariable analyses showed that people with low health literacy were more likely to be male, from a non-white ethnic group, live in a more deprived area, have spent fewer years in education, and were less likely to be employed.
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Age was borderline significant with people with low health literacy being slightly younger than people with adequate health literacy difference in mean age between groups 2. The variables remaining in the final multivariable model were age, gender, ethnicity white versus other , Indices of Multiple Deprivation score, years of education, employment; body mass index and alcohol intake, and anxiety scores Hospital Anxiety and Depression Scale HADS.
Service use analysis univariable only showed that people with low health literacy had significantly more, and longer, GP nurse consultations than people with adequate health literacy, but other service use showed no differences between groups. This study confirms that the characteristics of patients with low health literacy on UK GP CHD registers are similar to those seen in other long-term conditions in studies undertaken in other industrialised countries ie, membership of a minority ethnic group, socioeconomic deprivation, fewer years in education and lower income 9.
In contrast to other studies, 3—6 the patients with low health literacy in our study were slightly younger than the patients with adequate health literacy, although the difference between groups was small and should be interpreted with caution. We found that the prevalence of low health literacy to be close to that predicted from national general literacy levels.
In addition, people on GP CHD registers who have higher anxiety levels are more likely to have low health literacy than people with lower anxiety levels. This persists in the multivariable model, indicating an association over and above that already known to exist between anxiety and low socioeconomic status.
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The finding in the univariable analysis that patients with low health literacy had more contact with practice nurses but not with other health services requires further investigation. Our findings indicate that there is a disadvantaged group of people on GP CHD registers who have low health literacy in addition to other sociodemographic barriers to health.
A new finding is that these people have significantly higher anxiety levels than people with adequate health literacy. Our possible finding that people on GP CHD registers with lower health literacy consulted practice nurses more frequently will inform future Up-Beat pilot interventions 10 and our longitudinal cohort data will enable us to explore the impact of low health literacy on patients on GP CHD registers, and on their health service use.
Contributors GPR led on development of the research idea, contributed to interpretation of result and led on writing the paper. AM and SH collected research data and contributed to interpretation of results and writing the paper. RP led on statistical analysis of the data and interpretation of the results.
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PW conducted additional statistical analysis and contributed to the paper. AS contributed to the project design, analysis of results and writing the paper.
Patient Education Resources for Healthcare Professionals
Select a condition below to learn more. You may also download a handout highlighting all of our free patient resources. Learn more about HeartCare Channel. Kaiser Permanent Colorado researchers studied the association between low health literacy and all-cause mortality and hospitalization among outpatients with heart failure. Among patients with heart failure in an integrated managed care organization, low health literacy was significantly associated with higher all-cause mortality. The American Heart Association has created a Heart Attack Risk Calculator to help individuals discover their year risk of heart attack or death by coronary heart disease, along with what they can do about it.
The Centers for Disease Control and Prevention CDC have created a high blood pressure PDF fact sheet, designed to educate the public of the disease, its warning signs, and ways to control it. Details of the programs are included in the following links:. The National Center for Chronic Disease Prevention and Health Promotion has issued a PDF fact sheet regarding heart disease, detailing the risks, signs, and symptoms associated with it.