title: Health literacy of living kidney donors and kidney transplant recipients.
abstract: BACKGROUND
  Health literacy (HL) may be a mediator for known socioeconomic and racial disparities in living kidney donation.
  
  
  METHODS
  We evaluated the associations of patient and demographic characteristics with HL in living kidney donors (LD), living donor kidney transplant recipients (LDR), and deceased donor recipients (DDR) in a single-center retrospective review of patients undergoing kidney donation or transplantation from September 2010 to July 2012. HL and demographic data were collected. HL was assessed via the Short Literacy Survey (SLS) comprising three self-reported screening questions scored using the five-point Likert scale (low, moderate, high). Chi-square and logistic regression were used to test factors associated with lower HL.
  
  
  RESULTS
  The sample included 360 adults (105 LD, 103 LDR, and 152 DDR; 46±14 years; 70% white; 56% male; 14±3 years of education). HL scores were skewed (49% high, 41% moderate, and 10% low). The distribution of HL categories differed significantly among groups (P=0.019). After controlling for age, race, sex, education, and a race-education interaction term, DDR was more likely to have moderate or low HL than LDR (OR, 1.911; 95% CI, 1.096-3.332; P=0.022).
  
  
  CONCLUSIONS
  Overall, living donors had high HL. The distribution of low, moderate, and high HL differed significantly between LD, DDR, and LDR. DDR had a higher likelihood of having low HL than LDR. Screening kidney transplant candidates and donors for lower HL may identify barriers to living donation. Future interventions addressing HL may be important to increase living donation and reduce disparities.
authors.affiliation: 1 Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN. 2 Department of Surgery, Vanderbilt University Medical Center, Nashville, TN. 3 Vanderbilt University School of Medicine, Nashville, TN. 4 Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN. 5 Department of Medicine, Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN. 6 Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN. 7 Address correspondence to: Leigh Anne Dageforde, M.D., M.P.H., Vanderbilt Transplant Center 801 Oxford House Nashville, TN 37232.
authors.forename: Leigh Anne
authors.initials: LA
authors.lastname: Dageforde
authors.forename: Alec W
authors.initials: AW
authors.lastname: Petersen
authors.forename: Irene D
authors.initials: ID
authors.lastname: Feurer
authors.forename: Kerri L
authors.initials: KL
authors.lastname: Cavanaugh
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Harms
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Ehrenfeld
authors.forename: Derek E
authors.initials: DE
authors.lastname: Moore
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D054625:Healthcare Disparities; D006801:Humans; D016030:Kidney Transplantation / Q000523:psychology*; D019520:Living Donors / Q000523:psychology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010361:Patients / Q000523:psychology*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013714:Tennessee