Source: Masters Abstracts International, Volume: 81-06.

Advisor: Wang, Shiyi.

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Background: Health literacy has become an important determinant affecting healthcare utilization. Limited is known about the association between health literacy and end-of-life care expenditure, and whether rurality modifies the association.Methods: We conducted a county-level analysis, using health literacy data (estimated from U.S. Census, 2010 and American Community Surveys, 2011) and end-of-life expenditures in 2010 from Dartmouth Atlas database. Health literacy was categorized into two groups: low health literacy (LHL; health literacy score < 225) and high health literacy (HHL; health literacy score ≥ 225). Outcomes included expenditures in the last 6 months of life and terminal hospitalization. We applied hierarchical generalized linear regression controlling for county-level characteristics. We further evaluated the impact of rurality on the association between health literacy and end-of-life expenditures.Results: The study evaluated a total of 3,137 counties representing 303,897,545 individuals nationally. Counties with low health literacy have significantly higher mean expenditures in the last 6 months of life and terminal hospitalization (both P-values < .001). There was a statistically significant interaction between health literacy and rurality on expenditures (HHL*rural micropolitan p-value = .116; HHL*rural noncore p-value < .001). In the stratified analyses, low health literacy was associated with an increase of $6,200 in the last 6 months of life expenditures in urban areas (p = .003), but not significant in the rural micropolitan areas and rural noncore areas (p-values = .193 and .433, respectively).Conclusion: Overall, health literacy is significantly inversely associated with end-of-life care expenditure. However, it appeared no such association in rural areas. Interventions targeting health literacy to reduce end-of-life expenditures need to take the location of patient residence into account.

背景：健康素养已成为影响医疗保健利用率的重要决定因素。关于健康素养和临终医疗支出之间的关联以及农村是否改变这种关联的了解有限。方法：我们使用健康素养数据（根据2010年美国人口普查和2011年美国社区调查估算）和2010年达特茅斯地图集的寿命终了支出进行了县级分析。健康素养分为两类：低健康素养（LHL；健康素养分数<225）和高健康素养（HHL；健康素养分数≥225）。结果包括生命的最后六个月和末期住院的支出。我们针对县级特征应用了分层广义线性回归控制。我们进一步评估了农村人口对健康素养和报废支出之间联系的影响。结果：该研究评估了代表全国303,897,545个人的3,137个县。健康素养低的县在生命的最后6个月和末期住院期间的平均支出显着较高（均P值均＜.001）。卫生素养和农村支出之间存在统计学上的显着相互作用（HHL *农村小城市p-值= .116； HHL *农村非核心p-值<.001）。在分层分析中，低健康素养与城市地区过去6个月的生活支出增加了6,200美元相关（p = .003），但在农村小城市地区和农村非核心地区却不显着（p-value = .193和.433）。结论：总体而言，健康素养与临终护理费用成反比。但是，在农村地区似乎没有这种关联。针对健康素养的干预措施以减少寿命终了的支出，需要考虑患者居住地的位置。.