Low health numeracy is associated with higher disease activity in systemic lupus erythematosus

Abstract

Objective Evidence suggests low health literacy is prevalent in the United States and associated with worse clinical outcomes, yet few studies have investigated health literacy in systemic lupus erythematosus (SLE). The objective of this study was to determine the prevalence of low health literacy and numeracy in lupus patients and to examine its association with disease characteristics. Methods Patients with SLE were recruited from an academic center clinic. Participants completed in-person assessments of health literacy (Rapid Estimate of Adult Literacy in Medicine, REALM) and numeracy (Numeracy Understanding in Medicine Instrument Shortened Version, S-NUMi). Clinical disease activity measures were obtained, including urine protein to creatinine ratio (UPC), Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and physician global assessment (PhGA) scores. Results Ninety-five SLE patients participated in the study; 13% had low health literacy and 73% had limited health numeracy. Patients with lower health literacy and numeracy were more likely to be Black, have Medicaid insurance, and earn income <$50 K annually. In linear regression models, patients with limited health numeracy had, on average, PhGA scores 0.31 points higher (95% CI: 0.02, 0.60) than patients with adequate numeracy, after adjusting for race and age. No clinical outcomes were associated with health literacy. Conclusion In this exploratory study, we found SLE patients with low numeracy had higher disease activity. Our findings indicate that lower health literacy and numeracy are more common among Black and socioeconomically disadvantaged patients. Additional research will be needed to investigate the impact of health literacy on other outcomes and racial disparities in SLE.

The Relationship Between Health Literacy and Quality of Life, Attitudes and Perceptions of Covid-19 and Vaccination Among Patients with Systemic Autoimmune Diseases

“…Similarly, Katz et al observed that more than one-third of systemic lupus erythematosus patients (38%) had limited health literacy (Katz et al, 2021). Surprisingly, a recent study reported that, in a cohort of 95 SLE patients, the prevalence of low health literacy was 13%, which is much lower than our data (Maheswaranathan et al, 2021). This apparent inconsistency might be due to the tool used since in this study health literacy was measured by the rapid estimate of adult literacy in medicine (REALM) (Maheswaranathan et al, 2021) and it has been found to underestimated health literacy (Kordovski et al, 2017).…”

“…Surprisingly, a recent study reported that, in a cohort of 95 SLE patients, the prevalence of low health literacy was 13%, which is much lower than our data (Maheswaranathan et al, 2021). This apparent inconsistency might be due to the tool used since in this study health literacy was measured by the rapid estimate of adult literacy in medicine (REALM) (Maheswaranathan et al, 2021) and it has been found to underestimated health literacy (Kordovski et al, 2017). Among SAD patients, we found that the disease was associated with health literacy, with arthritis rheumatoid (88.9%) and systemic lupus erythematosus (76.8%) having the highest prevalence of inadequate health literacy.…”

“…Among SAD patients, we found that the disease was associated with health literacy, with arthritis rheumatoid (88.9%) and systemic lupus erythematosus (76.8%) having the highest prevalence of inadequate health literacy. Similar to previous research, we did not find any association between health literacy and perceived disease activity, medical specialist that controls the disease, lifestyle factors, and perceived health rating (Maheswaranathan et al, 2021).…”

Comprehension, Utility, and Acceptability of a Multidomain Physical Functioning Report for Systemic Lupus Erythematosus Patients and Their Providers

“…This is consistent with the qualitative feedback on a hypothetical cognitive functioning report that we recently gathered in this population (25). It may also reflect issues with low health numeracy, which may be more prevalent than low health literacy in SLE (26). Furthermore, this information provides additional targets for improvement of the report and for individualized education with respect to the delivery of a functioning report.…”

Health disparities in systemic lupus erythematosus—a narrative review

“…Study of health literacy in rheumatic diseases is sparse and is of interest given the association between limited health literacy and poor outcomes in other broader populations [ 79 ] Limited health numeracy was found to associate with higher disease activity in lupus patients [ 80 ]. Katz et al found that patients with SLE and limited health literacy gave worse patient-reported outcome scores [ 81 ].…”