Can we use preventive care utilization to estimate population health literacy

Background: Health literacy is the ability to obtain, understand, and use basic information to make appropriate health decisions. Currently, there is no validated national health literacy surveillance tool in the literature, which is directly related to health outcomes, and inversely to health care expenditures. National surveys such as the Behavioral Risk Factor Surveillance System lack a direct measure of health literacy, creating the need for a proxy variable. Objective: To assess the ability of the BRFSS to measure trends in adult health literacy. Methods: Preventive care utilization, associated with adequate health literacy, was analyzed using 2009 BRFSS data. Multivariate logistic models were used to regress 1)self-reported health status and 2)a history of one or more chronic conditions against time since last routine checkup as a proxy measure of health literacy, adjusting for race, age, gender, education, income, health coverage and having a primary care provider. Results: Adults without a recent checkup had higher odds of reporting one or more chronic conditions compared to those who had a checkup within the past 12 months (OR 1.26, 95%CI 1.16-1.36). Those without a recent checkup had lower odds of reporting poorer health status compared to those with a recent checkup (OR 0.78, 95%CI 0.72-0.84). Conclusions: Lower estimated health literacy was associated with increased odds of chronic conditions but not self-reported poor health status. Future research should confirm the association of our proxy variable with chronic conditions across multiple years, and future trends validated with concurrent large sample administration of a validated instrument.