Impact of low health literacy on healthcare utilization in individuals with cardiovascular disease, chronic obstructive pulmonary disease, diabetes and mental disorders: A Danish population-based 4-year follow-up study

TY - JOUR

T1 - Impact of low health literacy on healthcare utilization in individuals with cardiovascular disease, chronic obstructive pulmonary disease, diabetes and mental disorders

T2 - A Danish population-based 4-year follow-up study

AU - Friis, Karina

AU - Pedersen, Marie Hauge

AU - Aaby, Anna

AU - Lasgaard, Mathias

AU - Maindal, Helle Terkildsen

N1 - © The Author(s) 2020. Published by Oxford University Press on behalf of the European Public Health Association.

PY - 2020/10/1

Y1 - 2020/10/1

N2 - BACKGROUND: Previous research from the USA has shown that low health literacy is associated with higher hospitalization rates and higher rates of emergency service use. However, studies in a European context using more comprehensive health literacy definitions are lacking. The aim was to study the impact of low health literacy on healthcare utilization in a Danish context.METHODS: In this prospective cohort study, baseline survey data from 2013 were derived from a large Danish health and morbidity survey and merged with individual-level longitudinal register data for a 4-year follow-up period. The study included people in the general population (n = 29 473) and subgroups of people with four different chronic conditions: cardiovascular disease (CVD) (n = 2389), chronic obstructive pulmonary disease (COPD) (n = 1214), diabetes (n = 1685) and mental disorders (n = 1577).RESULTS: In the general population, low health literacy predicted slightly more visits to the general practitioner and admissions to hospital and longer hospitalization periods at 4 years of follow-up, whereas low health literacy did not predict planned outpatient visits or emergency room visits. In people with CVD, low health literacy predicted more days with emergency room visits. In people with mental disorders, difficulties in actively engaging with healthcare providers were associated with a higher number of hospital admission days. No significant association between health literacy and healthcare utilization was found for diabetes or COPD.CONCLUSIONS: Even though Denmark has a universal healthcare system the level of health literacy affects healthcare use in the general population and in people with CVD and mental disorders.

AB - BACKGROUND: Previous research from the USA has shown that low health literacy is associated with higher hospitalization rates and higher rates of emergency service use. However, studies in a European context using more comprehensive health literacy definitions are lacking. The aim was to study the impact of low health literacy on healthcare utilization in a Danish context.METHODS: In this prospective cohort study, baseline survey data from 2013 were derived from a large Danish health and morbidity survey and merged with individual-level longitudinal register data for a 4-year follow-up period. The study included people in the general population (n = 29 473) and subgroups of people with four different chronic conditions: cardiovascular disease (CVD) (n = 2389), chronic obstructive pulmonary disease (COPD) (n = 1214), diabetes (n = 1685) and mental disorders (n = 1577).RESULTS: In the general population, low health literacy predicted slightly more visits to the general practitioner and admissions to hospital and longer hospitalization periods at 4 years of follow-up, whereas low health literacy did not predict planned outpatient visits or emergency room visits. In people with CVD, low health literacy predicted more days with emergency room visits. In people with mental disorders, difficulties in actively engaging with healthcare providers were associated with a higher number of hospital admission days. No significant association between health literacy and healthcare utilization was found for diabetes or COPD.CONCLUSIONS: Even though Denmark has a universal healthcare system the level of health literacy affects healthcare use in the general population and in people with CVD and mental disorders.

KW - cardiovascular diseases

KW - diabetes mellitus

KW - chronic obstructive airway disease

KW - chronic disease

KW - Denmark

KW - emergency service

KW - hospital

KW - follow-up

KW - health personnel

KW - mental disorders

KW - outpatients

KW - physicians

KW - family

KW - health literacy

KW - hospital admission

KW - health care use

KW - universal health care

UR - http://www.scopus.com/inward/record.url?scp=85092680698&partnerID=8YFLogxK

U2 - 10.1093/eurpub/ckaa064

DO - 10.1093/eurpub/ckaa064

M3 - Journal article

C2 - 32335677

SN - 1101-1262

VL - 30

SP - 866

EP - 872

JO - European Journal of Public Health

JF - European Journal of Public Health

IS - 5

M1 - ckaa064

ER -