Abstract Body (Do not enter title and authors here): Introduction
Health literacy levels (HLL) in adults with chronic diseases correlate with health outcomes, especially in acquired cardiovascular disease. Data demonstrates that lower HLL correlate with lower education, and adult congenital heart disease (ACHD) patients have overall lower educational attainment. Currently, the HLL of ACHD patients is understudied and largely unknown. We hypothesized that adults with lower educational attainment would have a lower HLL.
Methods
We conducted a cross-sectional study of health literacy between March and June 2024 in a large tertiary care ACHD outpatient clinic. We included patients ≥18 years old with simple, moderate, or great complexity CHD who spoke English or Spanish. We excluded patients with significant developmental delay and intellectual disability. The primary outcome was the Newest Vital Sign (NVS) Score, a validated 6-point adult health literacy assessment tool, where low HLL is a NVS score of 0-3. Our primary predictor variable was education level. Covariables included age, race/ethnicity, primary language, insurance type, and transition program participation. Analysis was performed using univariable logistic regression (Stata v.17).
Results
Seventy-three in-person HLL assessments were completed. One patient was excluded for developmental delays on assessment. The median age was 32 years (25-75% IQR 24.5-46). Most of the cohort was female (58%) and had great complexity CHD (72.2%). Patients were 59.7% non-Hispanic White, 25% Hispanic, and 12.5% Black. 89% primarily spoke English. 72% had private insurance, and 76% had at least a high school education. The median NVS score was 5, with a range of 0-6 (Figure). Logistic regression demonstrated ~4x higher odds of low HLL for Hispanics (OR 3.92, 95% CI 1.07-14.33) and 4.6x higher odds of low HLL for public insurance (OR 4.6, 95% CI 1.23-17.23). There was no HLL association with age, education level, CHD severity, primary language, or transition program participation.
Conclusion
This is the largest study assessing the HLL of the ACHD population in the modern era. While education did not correlate with HLL, lower HLL in Hispanic and publicly insured patients underscores a need for further evaluation in these populations.