Limited literacy and mortality in the elderly: the health, aging, and body composition study.
BACKGROUND
While limited literacy is common and its prevalence increases with age, no prospective study has assessed whether limited literacy is associated with mortality in older adults.


OBJECTIVE
To assess the association of limited literacy with mortality.


METHODS
Five-year prospective study from 1999 to 2004 of community-dwelling elders from Memphis, TN, and Pittsburgh, PA, who were from the Health, Aging, and Body Composition study. Subjects' literacy was assessed with the Rapid Estimate of Adult Literacy in Medicine. Scores were categorized into limited (0 to 8th grade reading level) or adequate literacy (> or = 9th grade reading level).


METHODS
Two thousand five hundred and twelve black and white elders without baseline functional difficulties or dementia.


METHODS
Time to death.


RESULTS
Participants' mean age was 75.6 years, 48% were male, 38% were black, and 24% had limited literacy; the median follow-up time was 4.2 years. Compared with those with adequate literacy, those with limited literacy had a higher risk of death (19.7% vs 10.6%) with a hazard ratio (HR) of 2.03 (95% confidence intervals [CI], 1.62 to 2.55). After adjusting for demographics and socioeconomic status, co-morbid conditions, self-rated health status, health-related behaviors, health care access measures, and psychosocial status, limited literacy remained independently associated with mortality (HR 1.75; 95% CI, 1.27 to 2.41).


CONCLUSIONS
Limited literacy is independently associated with a nearly 2-fold increase in mortality in the elderly. Given the growth of the aging population and the prevalence of chronic diseases, the mechanisms by which limited literacy is associated with mortality in the elderly warrant further investigation.
Sudore
Rebecca L
RL
University of California, San Francisco, CA 94121, USA. rsucsf@yahoo.com
Yaffe
Kristine
K
Satterfield
Suzanne
S
Harris
Tamara B
TB
Mehta
Kala M
KM
Simonsick
Eleanor M
EM
Newman
Anne B
AB
Rosano
Caterina
C
Rooks
Ronica
R
Rubin
Susan M
SM
Ayonayon
Hilsa N
HN
Schillinger
Dean
D
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D001823:Body Composition; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006262:Health; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends; D011446:Prospective Studies; D012307:Risk Factors