Health literacy and the risk of hospital admission

OBJECTIVE:To determine the association between patient Literacy and hospita lization. DESIGN: Phospective cohort study. SETTING: Urban public hospital. PATIENTS:A total of 979 emergency department patients who participated in t he Literacy in Health Care study and had completed an intake interview and literacy testing with the Test of Functional Health Literacy in Adults were eligible for this study. Of these, 958 (97.8%) had an electronic medical r ecord available far 1994 and 1995. MEASUREMENTS AND MAIN RESULTS: Hospital admissions to Grady Memorial Hospit al during 1994 and 1995 were determined by the hospital information system. We used multivariate logistic regression to determine the independent asso ciation between inadequate functional health literacy and hospital admissio n. Patients with inadequate literacy were twice as likely as patients with adequate literacy to be hospitalized during 1994 and 1995 (31.5% vs 14.9%, p <.001). After adjusting for age, gender, race, self-reported health, soci oeconomic status, and health insurance, patients with inadequate literacy w ere more likely to be hospitalized than patients with adequate literacy (ad justed odds ratio [OR] 1.69; 95% confidence interval [CI] 1.13, 2.53). The association between inadequate literacy and hospital admission was stronges t among patients who had been hospitalized in the pear before study entry ( OR 3.15: 95% CI 1.45, 6.85). CONCLUSIONS:In this study population, patients with inadequate functional h ealth literacy had an increased risk of hospital admission.