title: Health literacy affects likelihood of radiology testing in the pediatric emergency department.
abstract: OBJECTIVE
  To test the hypothesis that the effect of race/ethnicity on decreased radiologic testing in the pediatric emergency department (ED) varies by caregiver health literacy.
  
  
  METHODS
  This was a secondary analysis of a cross-sectional study of caregivers accompanying children ≤ 12 years to a pediatric ED. Caregiver health literacy was measured using the Newest Vital Sign. A blinded chart review determined whether radiologic testing was utilized. Bivariate and multivariate analyses, adjusting for ED triage level, child insurance, and chronic illness were used to determine the relationship between race/ethnicity, health literacy, and radiologic testing. Stratified analyses by caregiver health literacy were conducted.
  
  
  RESULTS
  Five hundred four caregivers participated; the median age was 31 years, 47% were white, 37% black, 10% Hispanic, and 49% had low health literacy. Black race and low health literacy were associated with less radiologic testing (P < .01). In stratified analysis, minority race was associated with less radiologic testing only if a caregiver had low health literacy (aOR 0.5; 95% CI 0.3-0.9), and no difference existed in those with adequate health literacy (aOR 0.7; 95% CI 0.4-1.3).
  
  
  CONCLUSIONS
  Caregiver low health literacy modifies whether minority race/ethnicity is associated with decreased radiologic testing, with only children of minority caregivers with low health literacy receiving fewer radiologic studies. Future interventions to eliminate disparities in healthcare resource utilization should consider health literacy as a mutable factor.
authors.affiliation: Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI. Electronic address: akmorris@mcw.edu.
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Morrison
authors.affiliation: Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: David C
authors.initials: DC
authors.lastname: Brousseau
authors.affiliation: Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Ruta
authors.initials: R
authors.lastname: Brazauskas
authors.affiliation: Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Levas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017028:Caregivers / Q000592:standards*; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006266:Health Education; D057220:Health Literacy; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D011871:Radiology / Q000379:methods*; D012959:Socioeconomic Factors; D014218:Triage / Q000379:methods*; D055815:Young Adult