Health literacy and all-cause mortality among cancer patients

Abstract

Background

The association between health literacy and all-cause mortality among cancer patients remains unclear.

Methods

This is a retrospective cohort study of 9603 patients diagnosed with prostate, lung, breast, renal, colorectal, brain, head and neck, bladder, pancreatic, liver, sarcoma, and gastric cancers who were screened for health literacy between 2008 and 2018, using the Brief Health Literacy Screen (BHLS). Higher scores (range, 3–15) indicate higher health literacy. The association between all-cause mortality and health literacy was estimated using multivariable Cox proportional hazards models.

Results

A total of 8608 (89%) patients were non-Hispanic White. The median follow-up was 3.1 years. Patients with a BHLS score of 15 had a median survival improvement of 9.4 months (95% confidence interval [CI], 6.0–13.2 months) compared to those with a score of 9. Lower BHLS scores (9 vs. 15) were associated with higher mortality in stages II (adjusted hazard ratio [aHR], 2.6 [95% CI, 1.5–5.1]) and III (aHR 2.9 [95% CI, 1.4-6.0]) prostate cancer; stages I (aHR 1.7 [95% CI, 1.1–2.5]) and IV (aHR, 1.6 [95% CI, 1.2–2.1]) lung cancer; stage I colorectal cancer (aHR, 2.2 [95% CI, 1.3–4.7]); stage I renal cancer (aHR, 1.8 [95% CI, 1.1–3.4]); stages I (aHR, 2.6 [95% CI, 1.3–7.1]) and IV (aHR, 1.7 [95% CI, 1.2–2.7]) head and neck cancer; stage II bladder cancer (aHR, 1.6 [95% CI, 1.0–2.8]); stage I liver cancer (aHR, 4.1 [95% CI, 1.9–9.3]); and all stages of breast cancer.

Conclusions

Lower health literacy was associated with higher all-cause mortality among patients with 12 different types of cancer, varying by cancer type and stage.