Associations of health literacy with socioeconomic position, health risk behavior, and health status: a large national population-based survey among Danish adults

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  • Majbritt Tang Svendsen, Centre for Clinical Research, North Denmark Regional Hospital / Clinical Institute of Medicine, Aalborg University , Hjørring, Denmark. majbritt.svendsen@rn.dk., Department of Cardiology, North Denmark Regional Hospital, Bispensgade 37, 9800, Hjørring, Denmark., Danmark
  • Carsten Kronborg Bak, Department of Research and Development, University College South, Kolding, Denmark., Danmark
  • Kristine Sørensen, Global Health Literacy Academy, Risskov, Denmark., Danmark
  • Jürgen Pelikan, Gesundheit Österreich GmbH (Austrian Public Health Institute), Vienna, Austria., Østrig
  • Signe Juul Riddersholm, Department of Anesthesia and Intensive Care Medicine, Center for Cardiovascular Research, Aalborg University Hospital, Denmark, Danmark
  • Regitze Kuhr Skals, Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark; Clinical Institute, Aalborg University, Denmark.
  • ,
  • Rikke Nørmark Mortensen, Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark; Clinical Institute, Aalborg University, Denmark., Danmark
  • Helle Terkildsen Maindal
  • Henrik Bøggild, Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark; Clinical Institute, Aalborg University, Denmark., Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
  • ,
  • Gitte Nielsen, Department of Cardiology, North Denmark Regional Hospital, Bispensgade 37, 9800, Hjørring, Denmark., Danmark
  • Christian Torp-Pedersen, Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark., Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark., Danmark

BACKGROUND: Health literacy concerns the ability of citizens to meet the complex demands of health in modern society. Data on the distribution of health literacy in general populations and how health literacy impacts health behavior and general health remains scarce. The present study aims to investigate the prevalence of health literacy levels and associations of health literacy with socioeconomic position, health risk behavior, and health status at a population level.

METHODS: A nationwide cross-sectional survey linked to administrative registry data was applied to a randomly selected sample of 15,728 Danish individuals aged ≥25 years. By the short form HLS-EU-Q16 health literacy was measured for the domains of healthcare, disease prevention, and health promotion. Adjusted multinomial logistic regression analyses were used to estimate associations of health literacy with demographic and socioeconomic characteristics, health risk behavior (physical activity, smoking, alcohol consumption, body weight), and health status (sickness benefits, self-assessed health).

RESULTS: Overall, 9007 (57.3%) individuals responded to the survey. Nearly 4 in 10 respondents faced difficulties in accessing, understanding, appraising, and applying health information. Notably, 8.18% presented with inadequate health literacy and 30.94% with problematic health literacy. Adjusted for potential confounders, regression analyses showed that males, younger individuals, immigrants, individuals with basic education or income below the national average, and individuals receiving social benefits had substantially higher odds of inadequate health literacy. Among health behavior factors (smoking, high alcohol consumption, and inactivity), only physical behavior [sedentary: OR: 2.31 (95% CI: 1.81; 2.95)] was associated with inadequate health literacy in the adjusted models. The long-term health risk indicator body-weight showed that individuals with obesity [OR: 1.78 (95% CI: 1.39; 2.28)] had significantly higher odds of lower health literacy scores. Poor self-assessed health [OR: 4.03 (95% CI: 3.26; 5.00)] and payments of sickness absence compensation benefits [OR: 1.74 (95% CI: 1.35; 2.23)] were associated with lower health literacy scores.

CONCLUSIONS: Despite a relatively highly educated population, the prevalence of inadequate health literacy is high. Inadequate health literacy is strongly associated with a low socioeconomic position, poor health status, inactivity, and overweight, but to a lesser extent with health behavior factors such as smoking and high alcohol consumption.

OriginalsprogEngelsk
Artikelnummer565
TidsskriftBMC Public Health
Vol/bind20
Nummer1
Antal sider12
ISSN1471-2458
DOI
StatusUdgivet - 2020

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