Health literacy and falls among community-dwelling older people in China: is there a sex difference?

Background: Health literacy is one of the important determinants of healthy aging, yet few studies have focused on the association between health literacy and falls.

Aims: This study aims to explore the relationship between health literacy and falls, with a focus on sex differences among older people in China.

Methods: This cross-sectional study enrolled 2,144 older people aged ≥ 60 years from Shandong Province, China in 2021. We used general health literacy screening scale to assess health literacy, and collected the incidence of falls in the past year. Logistic regression models were employed to analyze the relationship between health literacy and falls. We investigated the sex differences by subgroup analyses.

Results: The prevalence of adequate health literacy and falls was 21.7% (95% CI: 20.0-23.5%) and 25.4% (95% CI: 23.6-27.3%), respectively. In a fully-adjusted model, adequate health literacy was associated with a lower prevalence of falls in older adults (OR = 0.71, 95%CI: 0.52-0.96). Subgroup analysis revealed sex differences in this relationship (P_{for interaction} <0.05). Specifically, the female group showed no significant relationship between health literacy and falls (OR = 0.92, 95% CI: 0.59-1.44); however, the male group demonstrated a robust and significant relationship (OR = 0.58, 95% CI: 0.37-0.90).

Conclusions: Older people with adequate health literacy have lower prevalence of falls, which appears to differ by sex. This relationship was significant among men but not among women. These findings emphasize the need for policymakers and healthcare providers to consider sex differences when designing and implementing programs aimed at improving health literacy and preventing falls in the older population. Improving health literacy among older women could be a strategic component in bridging sex inequality in falls.