Impact of Health Literacy, Social Support, and Socioeconomic Position on Serum Uric Acid Level of Asymptomatic Hyperuricemia Patients in China: a structural equation model

Abstract

Background Hyperuricemia poses a significant public health challenge on a global scale, with a concerning trend of affecting younger populations, while the rates of awareness and control remain suboptimal. The role of health literacy in influencing health outcomes is of utmost importance, and enhancing health literacy is helpful for patients in managing risk factors. Additionally, social support and socioeconomic position (SEP) have been identified as potential factors influencing health. However, the precise relationship between these factors and hyperuricemia remains uncertain. The study aims to investigate the status of health literacy among patients with hyperuricemia and explore the relationship between health literacy, social support, SEP, and serum uric acid. Methods A cross-sectional study was conducted among 349 participants with asymptomatic hyperuricemia in Luzhou of China. The research instrument included the Sociodemographics characteristics questionnaire, Health Literacy Management Scale (HeLMS), and Social Support Scale (SSRS). The construction of the SEP index was achieved through the application of principal component analysis. Univariate and hierarchical regression analyses were used to measure the association of health literacy, social support, SEP, and serum uric acid. Furthermore, structural equation modeling (SEM) was utilized to examine this association. Results (1) Most patients exhibited low health literacy (90.18 ± 15.11), and only 44.4% possess basic health literacy. (2) SEP was positively correlated with SUA (β = 4.086, P< 0.001), health literacy was negatively related to SUA level (β = -0.399, P < 0.001). There was no significant relationship between social support and SUA (β = 0.051, P= 1.085). (3) Health literacy mediates the association between SEP and serum uric acid (β = -0.490, 95% CI: -0.620 to -0.382). The direct effect of SEP on SUA and health literacy was 0.723 and 0.696, respectively and the total effect of SEP on SUA was 0.233. Conclusions The findings indicate a low level of health literacy among patients with AHU and suggest that health literacy may play a mediating role in the relationship between socioeconomic position (SEP) and serum uric acid (SUA) levels. Consequently, it is recommended that future initiatives prioritize health literacy and devise appropriate intervention strategies to enhance the self-management capabilities of patients with AHU.