title: Health literacy and health outcomes in chronic obstructive pulmonary disease.
abstract: There is little information worldwide about the impact of health literacy (HL) on clinical outcomes of COPD. Our aim was to quantify inadequate HL in Spain, as measured by the Short Assessment of Health Literacy for Spanish Adults questionnaire, and to examine the associations between HL and both COPD outcomes and health status.
  
  
  
  296 COPD patients of 68(SD = 9) years and a FEV1%predicted of 53%(SD = 18%) were enrolled and followed-up for one year. 59% showed "inadequate" HL.
  
  
  
  Individuals with inadequate HL were older (70[SD = 9] vs 65[SD = 8] years; p < 0.001) and had less knowledge of their disease, as measured by the low HL-COPD questionnaire, (6.9[SD = 2.3] vs 7.5[SD = 1.9]; p < 0.001). While their lung function was no different, they reported significant differences in mMRC (1.6[SD = 1] vs 1.4[SD = 1]; p < 0.001), CAT (19.2[SD = 8.1] vs 18.3[SD = 7.5]; p = 0.049), and EQ-5 (3.1[SD = 2.2] vs 2.3[SD = 1.9]; p < 0.00). Those with inadequate HL had also higher risk of having ≥2 comorbidities (OR = 1.87; 95%CI = 1.14-3.08), need of assistance (OR = 2.5; 95%CI = 1.5-4.2), anxiety/depression (OR = 1.9; 95%CI = 1.2-3.0), admissions or visits to the emergency department (OR = 1.70; 95%CI = 1.1-2.7), and all-cause deaths in the following year (3.8% (SE = 1.1%) vs 0%; p = 0.051).
  
  
  
  Inadequate HL is prevalent among COPD patients and it is related to health status and relevant clinical outcomes of the disease. HL needs to be considered when planning the care for COPD patients.
authors.affiliation: Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Instituto de investigación Sanitaria Gregorio Marañón, Facultad de Medicina Universidad Complutense, Madrid, Spain. Electronic address: Lpuente@separ.es.
authors.forename: Luis
authors.initials: L
authors.lastname: Puente-Maestu
authors.affiliation: Servicio de Neumología, Hospital Clínico San Carlos, Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain.
authors.forename: Myriam
authors.initials: M
authors.lastname: Calle
authors.affiliation: Servicio de Neumología, Hospital Clínico San Carlos, Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain.
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Rodríguez-Hermosa
authors.affiliation: Ferrer International Laboratorios, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Campuzano
authors.affiliation: Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Instituto de investigación Sanitaria Gregorio Marañón, Facultad de Medicina Universidad Complutense, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: de Miguel Díez
authors.affiliation: Servicio de Neumología, Hospital Clínico San Carlos, Madrid, Spain; Facultad de Medicina, Universidad Complutense, Madrid, Spain.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Álvarez-Sala
authors.affiliation: Instituto de investigación Sanitaria Gregorio Marañón, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Puente-Andues
authors.affiliation: Ferrer International Laboratorios, Spain.
authors.forename: Maria Joselín
authors.initials: MJ
authors.lastname: Pérez-Gutiérrez
authors.affiliation: Department of Health Policy and Management, School of Global Public Health, University of North Carolina, Chapel Hill, USA.
authors.forename: Shoou-Yih D
authors.initials: SY
authors.lastname: Lee
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D051341:Dependent Ambulation / Q000523:psychology; D003863:Depression / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy / Q000706:statistics & numerical data* / Q000639:trends; D006304:Health Status; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D017063:Outcome Assessment, Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000503:physiopathology*; D011788:Quality of Life; D012129:Respiratory Function Tests / Q000379:methods; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires
keywords: COPD; Daily living activities; Dependence; Health outcomes; Health status; Utility; Utilization