title: Health literacy in an urban elderly East-German population - results from the population-based CARLA study.
abstract: BACKGROUND
  Health literacy (HL) has gained increasing attention in public health research. However, until now research was mainly focused on clinical settings rather than on the general population. Due its relation to social determinants and health outcomes, HL is of special interest in epidemiological studies. The aim of the present study was therefore to describe HL among an elderly general high-risk population, to analyze the potential contributing factors of HL, and to analyze the impact of HL on health-related outcomes.
  
  
  METHODS
  We used data from the CARLA Study, which is a prospective population-based cohort study of the elderly general population of the city of Halle (Saale) in Eastern Germany. The short version of the HLS-EU Questionnaire (HLS-EU-Q16) was administered with 1,107 subjects aged between 55 and 91 year old. A HL score ranging from 0 to 50 points was computed and classified according to the recommendation of the HLS-EU project. Socio-economic as well as health-related variables were determined during the standardized interview and clinical examination. We calculated linear as well as logistic regression models in order to analyze the association between HL and health-related outcomes as well as potential influencing factors of HL.
  
  
  RESULTS
  Overall, the HL score was 36.9 (SD 6.9). Among all subjects, 4 % showed inadequate HL, 23 % problematic HL, 50 % sufficient HL, and 23 % excellent HL. HL was positively associated with educational level, net household income, and self-perceived social position. Further, we found an increase of HL with age (β = 0.10; 95 % CL 0.05; 0.15) and a lower HL score among women compared with men (Diff = -1.4; 95 % CL -2.2; -0.6). An inverse association was observed between HL and diabetes among both sexes (OR 0.93; 95 % CL 0.93; 0.98), between HL and myocardial infarction among women, and between HL and stroke among men.
  
  
  CONCLUSIONS
  In this elderly general Eastern German population, we found higher HL score values compared with previous studies using the same questionnaire. HL was associated with socio-economic status. Furthermore, this cross-sectional study could show associations between HL and different health-related outcomes even after adjustment for educational level. However, further research is needed in order to evaluate the impact of HL on health-related outcomes using longitudinal data derived from the general population.
authors.affiliation: Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin Luther University of Halle-Wittenberg, Magdeburger Straße 8, Halle (Saale), Germany. daniel.tiller@medizin.uni-halle.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Tiller
authors.affiliation: Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin Luther University of Halle-Wittenberg, Magdeburger Straße 8, Halle (Saale), Germany. beatrice.herzog@medizin.uni-halle.de.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Herzog
authors.affiliation: Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin Luther University of Halle-Wittenberg, Magdeburger Straße 8, Halle (Saale), Germany. alexander.kluttig@medizin.uni-halle.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kluttig
authors.affiliation: Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin Luther University of Halle-Wittenberg, Magdeburger Straße 8, Halle (Saale), Germany. johannes.haerting@medizin.uni-halle.de.
authors.forename: Johannes
authors.initials: J
authors.lastname: Haerting
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus; D005260:Female; D005858:Germany; D057220:Health Literacy / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D016017:Odds Ratio; D011446:Prospective Studies; D012923:Social Class; D020521:Stroke; D011795:Surveys and Questionnaires; D014505:Urban Population