CANCER HEALTH LITERACY AND HOSPITALIZATION IN THE FIRST FIVE YEARS FOLLOWING A CANCER DIAGNOSIS

BACKGROUND: The field of health literacy research has been focused recently on developing more accurate measurement tools and understanding the relationship between health literacy and health outcomes. Individuals with lower levels of health literacy have worse health outcomes, including hospitalization rates, compared to those with adequate health literacy. This relationship has yet to be examined in the cancer patient population, although significant relationships between health literacy and cancer knowledge, screening behavior and quality of life have been found. This study is the first to examine the relationship between health literacy and hospitalization rates in a cancer patient population, and the first to examine the relationship between health literacy and health outcomes using the recently developed Cancer Health Literacy Tests (CHLT-30, CHLT-6). METHOD: These secondary data analyses matched data collected during the larger Cancer Health Literacy Study (CHLS) to hospital data from electronic medical records. This study examined the data of 778 CHLS participants interviewed within the first five years of their cancer diagnosis. The outcomes of interest were the number of inpatient hospital admissions, the total number of days spent hospitalized, and the number of 30-day hospital readmissions. Multivariate multiple negative binomial regression modeling was done to identify predictors of the three hospitalization outcomes. RESULTS: The CHLT-30 was found to significantly predict number of inpatient admissions when controlling for confounding variables, total days hospitalized, and number of readmissions. The CHLT-6 significantly predicted total days spent hospitalized when controlling for number of inpatient admissions, number of 30-day readmissions, treatment, race, stage, number of comorbidities, dying, and education level, with those with limited health literacy spending more days in the hospital as compared to those with adequate health literacy. CONCLUSION: This study produced mixed results regarding the significance of health literacy in predicting hospitalization rates in a cancer patient population. However, this study provides evidence that health literacy may be a mediator in this relationship and further work should be done to test a full or partial mediation model