Racial Disparities in Health Literacy and Access to Care Among Patients With Heart Failure

被引:98
作者
Chaudhry, Sarwat I. [1 ]
Herrin, Jeph [2 ]
Phillips, Christopher [3 ]
Butler, Javed [4 ]
Mukerjhee, Sandip [2 ]
Murillo, Jaime [5 ]
Onwuanyi, Anekwe [2 ]
Seto, Todd B. [6 ]
Spertus, John [7 ,8 ]
Krumholz, Harlan M. [9 ,10 ,11 ]
机构
[1] Yale Univ, Sch Med, Sect Gen Med, Dept Internal Med, New Haven, CT 06520 USA
[2] Yale Univ, Sch Med, Sect Cardiovasc Med, Dept Internal Med, New Haven, CT 06520 USA
[3] Morehouse Sch Med, Dept Med, Atlanta, GA 30310 USA
[4] Emory Univ, Div Cardiol, Dept Internal Med, Atlanta, GA 30322 USA
[5] Sentara Cardiac Res Inst, Norfolk, VA USA
[6] Univ Hawaii, Sch Med, Queens Med Ctr, Honolulu, HI 96822 USA
[7] St Lukes Hosp, Cardiovasc Educ & Outcomes Res Mid Amer Heart Ins, Kansas City, MO 64111 USA
[8] Univ Missouri, Sect Cardiovasc Med, Dept Internal Med, Kansas City, MO 64110 USA
[9] Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA
[10] Yale Univ, Sch Med, Sect Hlth Policy & Adm, Dept Epidemiol & Publ Hlth, New Haven, CT 06520 USA
[11] Yale Univ, Sch Med, Robert Wood Johnson Clin Scholars Program, New Haven, CT 06520 USA
关键词
Heart failure; racial disparities; health literacy; access to care; AFRICAN-AMERICAN PATIENTS; SOCIAL SUPPORT; SELF-CARE; OUTCOMES; SYSTEMS; DESIGN; GENDER; ADULTS; RACE;
D O I
10.1016/j.cardfail.2010.09.016
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Previous work has shown that there is a higher frequency of hospitalizations among black heart failure patients relative to white heart failure patients. We sought to determine whether racial differences exist in health literacy and access to outpatient medical care, and to identify factors associated with these differences. Methods: We evaluated data from 1464 heart failure patients (644 black and 820 white). Health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine-Revised (ie, REALM-R), and access to care was assessed through participants' self-report. Results: Black race was strongly associated with worse health literacy and all measures of poor access to care in unadjusted analyses. After adjusting for demographics, noncardiac comorbidity, social support, insurance status, and socioeconomic status (income and education), the strongest associations were seen between race and: health literacy (OR 2.13, 95% CI 1.46 to 3.10), absence of a medical home (OR 1.76, 1.19-2.61), and cost as a deterrent to seeking health care (OR 1.55, 1.07 to 2.23). Conclusions: Our findings highlight that important racial differences in health literacy and access to care exist among patients with heart failure. These differences persist even after adjustment for a broad range of potential mediators, including educational attainment, income, and insurance status. (J Cardiac Fail 2011;17:122-127)
引用
收藏
页码:122 / 127
页数:6
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