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The impact of limited health literacy on patient-reported outcomes in systemic lupus erythematosus

Author

Arthritis Care Res (Hoboken). 2020 Aug 2. doi: 10.1002/acr.24361. Online ahead of print.

Patricia Katz 1, Maria Dall'Era 1, Laura Trupin 1, Stephanie Rush 1, Louise B Murphy 2, Cristina Lanata 1, Lindsey A Criswell 1, Jinoos Yazdany 1

Author Information

1 University of California San Francisco, United States.

2 Centers for Disease Control and Prevention, Atlanta, United States.

Abstract

Objective: Health disparities in patient-reported outcomes (PROs) by income and education are well documented; the impact of health literacy on PROs has received less attention. We examined independent effects of income, education, and health literacy on PROs in SLE.

Methods: Data from the California Lupus Epidemiology Study (CLUES, n=323) were used. Health literacy was assessed with a validated 3-item measure (ability to understand written information, reliance on others to understand written information, confidence in completing written forms). PROs were administered by interview in English, Spanish, Cantonese, or Mandarin. Generic and disease-specific PROs were examined: ten PROMIS short forms, the eight SF-36 subscales, and three patient-reported SLE disease activity and damage measures. We conducted two sets of multivariable analyses: the first examined education, income, or health literacy individually; the second included all three simultaneously. All multivariable models included age, sex, race/ethnicity, language, disease duration, and physician-assessed disease activity and damage.

Results: Over one-third (38%) had limited health literacy (LHL), including >25% with greater than high school education. In multivariable analyses simultaneously considering education, income, and health literacy, LHL was associated with significantly worse scores on all PROs except disease damage. In contrast, disparities by income were seen in only three PROMIS scales, three SF-36 subscales, and one disease activity measure. No disparities by education level were noted.

Conclusions: We found significantly worse PRO scores among individuals with LHL, even after controlling for disease activity and damage. Whether disparities are due to actual differences in health or measurement issues requires further study.