TY - JOUR
T1 - Limited health literacy and adverse outcomes among kidney transplant candidates
AU - Warsame, Fatima
AU - Haugen, Christine E.
AU - Ying, Hao
AU - Garonzik-Wang, Jacqueline M.
AU - Desai, Niraj M.
AU - Hall, Rasheeda K.
AU - Kambhampati, Rekha
AU - Crews, Deidra C.
AU - Purnell, Tanjala S.
AU - Segev, Dorry L.
AU - McAdams-DeMarco, Mara A.
N1 - Funding Information:
We would like to thank the study participants for their contributions to this study. This study was supported by National Institutes of Health grants R01AG042504 (PI: Dorry Segev), R01AG055781 (PI: McAdams-DeMarco), R01DK114074 (PI: McAdams-DeMarco), and K24DK101828 (PI: Dorry Segev). Mara McAdams-DeMarco was supported by the Johns Hopkins University Claude D. Pepper Older Americans Independence Center (P30AG021334) and the National Institute on Aging (K01AG043501). Christine Haugen was supported by the National Institute on Aging (F32AG053025). Deidra Crews was supported by the National Institute of Diabetes, Digestive, and Kidney Diseases (K23DK097184). Rasheeda Hall was supported by the Duke Claude D. Pepper Older Americans Independence Center (P30AG028716), the Doris Duke Charitable Foundation (2015207), and the National Center for Advancing Translational Sciences (KL2TR001115). Tanjala Purnell was supported by the Agency for Healthcare Research and Quality (K01HS024600). Rekha Kambhampati was supported by the National Institute of Diabetes, Digestive, and Kidney Diseases (T32DK00773).
Publisher Copyright:
© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2019/2
Y1 - 2019/2
N2 - More than one-third of US adults have limited health literacy, putting them at risk of adverse clinical outcomes. We evaluated the prevalence of limited health literacy among 1578 adult kidney transplant (KT) candidates (May 2014-November 2017) and examined its association with listing for transplant and waitlist mortality in this pilot study. Limited health literacy was assessed at KT evaluation by using a standard cutoff score ≤5 on the Brief Health Literacy Screen (score range 0-12, lower scores indicate worse health literacy). We used logistic regression and adjusted Cox proportional hazards models to identify risk factors for limited health literacy and to quantify its association with listing and waitlist mortality. We found that 8.9% of candidates had limited health literacy; risk factors included less than college education (adjusted odds ratio [aOR] = 2.87, 95% confidence interval [CI]:1.86-4.43), frailty (aOR = 1.85, 95% CI:1.22-2.80), comorbidity (Charlson comorbidity index [1-point increase] aOR = 1.12, 95% CI: 1.04-1.20), and cognitive impairment (aOR = 3.45, 95% CI: 2.20-5.41) after adjusting for age, sex, race, and income. Candidates with limited health literacy had a 30% (adjusted hazard ratio = 0.70, 95% CI: 0.54-0.91) decreased likelihood of listing and a 2.42-fold (95% CI: 1.16- to 5.05-fold) increased risk of waitlist mortality. Limited health literacy may be a salient mechanism in access to KT; programs to aid candidates with limited health literacy may improve outcomes and reduce disparities.
AB - More than one-third of US adults have limited health literacy, putting them at risk of adverse clinical outcomes. We evaluated the prevalence of limited health literacy among 1578 adult kidney transplant (KT) candidates (May 2014-November 2017) and examined its association with listing for transplant and waitlist mortality in this pilot study. Limited health literacy was assessed at KT evaluation by using a standard cutoff score ≤5 on the Brief Health Literacy Screen (score range 0-12, lower scores indicate worse health literacy). We used logistic regression and adjusted Cox proportional hazards models to identify risk factors for limited health literacy and to quantify its association with listing and waitlist mortality. We found that 8.9% of candidates had limited health literacy; risk factors included less than college education (adjusted odds ratio [aOR] = 2.87, 95% confidence interval [CI]:1.86-4.43), frailty (aOR = 1.85, 95% CI:1.22-2.80), comorbidity (Charlson comorbidity index [1-point increase] aOR = 1.12, 95% CI: 1.04-1.20), and cognitive impairment (aOR = 3.45, 95% CI: 2.20-5.41) after adjusting for age, sex, race, and income. Candidates with limited health literacy had a 30% (adjusted hazard ratio = 0.70, 95% CI: 0.54-0.91) decreased likelihood of listing and a 2.42-fold (95% CI: 1.16- to 5.05-fold) increased risk of waitlist mortality. Limited health literacy may be a salient mechanism in access to KT; programs to aid candidates with limited health literacy may improve outcomes and reduce disparities.
KW - clinical research/practice
KW - kidney transplantation/nephrology
KW - patient characteristics
KW - patient survival
UR - http://www.scopus.com/inward/record.url?scp=85052645127&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85052645127&partnerID=8YFLogxK
U2 - 10.1111/ajt.14994
DO - 10.1111/ajt.14994
M3 - Article
C2 - 29962069
AN - SCOPUS:85052645127
SN - 1600-6135
VL - 19
SP - 457
EP - 465
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 2
ER -