title: Racial disparities in health literacy and access to care among patients with heart failure.
abstract: BACKGROUND
  Previous work has shown that there is a higher frequency of hospitalizations among black heart failure patients relative to white heart failure patients. We sought to determine whether racial differences exist in health literacy and access to outpatient medical care, and to identify factors associated with these differences.
  
  
  METHODS
  We evaluated data from 1464 heart failure patients (644 black and 820 white). Health literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine-Revised (ie, REALM-R), and access to care was assessed through participants' self-report.
  
  
  RESULTS
  Black race was strongly associated with worse health literacy and all measures of poor access to care in unadjusted analyses. After adjusting for demographics, noncardiac comorbidity, social support, insurance status, and socioeconomic status (income and education), the strongest associations were seen between race and: health literacy (OR 2.13, 95% CI 1.46 to 3.10), absence of a medical home (OR 1.76, 1.19-2.61), and cost as a deterrent to seeking health care (OR 1.55, 1.07 to 2.23).
  
  
  CONCLUSIONS
  Our findings highlight that important racial differences in health literacy and access to care exist among patients with heart failure. These differences persist even after adjustment for a broad range of potential mediators, including educational attainment, income, and insurance status.
authors.affiliation: Department of Internal Medicine, Section of General Medicine, Yale University School of Medicine, New Haven, CT 06520, USA. sarwat.chaudhry@yale.edu
authors.forename: Sarwat I
authors.initials: SI
authors.lastname: Chaudhry
authors.forename: Jeph
authors.initials: J
authors.lastname: Herrin
authors.forename: Christopher
authors.initials: C
authors.lastname: Phillips
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.forename: Sandip
authors.initials: S
authors.lastname: Mukerjhee
authors.forename: Jaime
authors.initials: J
authors.lastname: Murillo
authors.forename: Anekwe
authors.initials: A
authors.lastname: Onwuanyi
authors.forename: Todd B
authors.initials: TB
authors.lastname: Seto
authors.forename: John
authors.initials: J
authors.lastname: Spertus
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054624:Health Status Disparities; D006305:Health Status Indicators; D006333:Heart Failure / Q000453:epidemiology / Q000208:ethnology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D044469:Racial Groups / Q000706:statistics & numerical data*; D012944:Social Support; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data