title: Health literacy and access to kidney transplantation.
abstract: OBJECTIVE
  Few studies have examined health literacy in patients with end stage kidney disease. We hypothesized that inadequate health literacy in a hemodialysis population is common and is associated with poorer access to kidney transplant wait-lists.
  
  
  METHODS
  We enrolled 62 Black and White maintenance hemodialysis patients aged 18 to 75. We measured health literacy using the short form Test of Functional Health Literacy in Adults. Our primary outcomes were (1) time from dialysis start date to referral date for kidney transplant evaluation and (2) time from referral date to date placed on kidney transplant wait-list. We used Cox proportional hazard models to examine the association between health literacy (adequate versus inadequate) and our outcomes after controlling for demographics and co-morbid conditions.
  
  
  RESULTS
  Roughly one third (32.3%) of participants had inadequate health literacy. Forty-seven (75.8%) of participants were referred for transplant evaluation. Among those referred, 40 (85.1%) were wait-listed. Participants with inadequate health literacy had 78% lower hazard of referral for transplant evaluation than those with adequate health literacy (adjusted hazard ratio [AHR] 0.22; 95% confidence interval 0.08, 0.60; P = 0.003). The hazard ratio of being wait-listed by health literacy was not statistically different (AHR 0.80, 95% CI, 0.39, 1.61), P = 0.5).
  
  
  CONCLUSIONS
  Inadequate health literacy is common in our hemodialysis patient population and is associated with a lower hazard of referral for transplant evaluation. Strategies to reduce the impact of health literacy on the kidney transplant process should be explored.
authors.affiliation: Division of Nephrology, Department of Medicine, University of California San Francisco, California, San Francisco, CA 94143-0532, USA. vgrubbs@medicine.ucsf.edu
authors.forename: Vanessa
authors.initials: V
authors.lastname: Grubbs
authors.forename: Steven E
authors.initials: SE
authors.lastname: Gregorich
authors.forename: Eliseo J
authors.initials: EJ
authors.lastname: Perez-Stable
authors.forename: Chi-Yuan
authors.initials: CY
authors.lastname: Hsu
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D032882:Comprehension; D004522:Educational Status; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000601:surgery / Q000628:therapy*; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008875:Middle Aged; D010353:Patient Education as Topic; D016016:Proportional Hazards Models; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D012495:San Francisco / Q000453:epidemiology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014850:Waiting Lists; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult