Impact of Health Literacy and Social Support on the Survival of Hispanic Chronic Kidney Disease Patients

Abstract

ABSTRACT Background:

Chronic kidney disease (CKD) is a significant public health concern in the United States (U.S.), particularly among Hispanic populations, as its prevalence is rising. Limited health literacy (HL) in CKD patients hinders self-management of the disease and health-related outcomes. Social support (SS) significantly influences CKD patient outcomes, yet its interplay with HL remains unexplored. We investigated HL, perceived SS, and sociodemographic factors among Hispanic CKD patients, assessing their impact on mortality related-risk. Methods:

We analyzed data stemming from the Hispanic sub cohort of the Chronic Renal Insufficiency Cohort (CRIC) study, a longitudinal examination of CKD and cardiovascular disease risk factors over 15 years. Measures included HL (Short Test of Functional Health Literacy in Adults), SS (Medical Outcomes Study Social Support Survey), and sociodemographic factors, with marital status as a metric for SS. We conducted linear regressions to examine the relationship between HL, SS, a sociodemographic factor. Additionally, we conducted a series of Cox proportional hazards models to assess the impact of HL, SS, and sociodemographic factors on survival outcomes. Results:

While a total of 327 individuals were enrolled in the H-CRIC study, only 140 participants were included in the current study due to having complete data at year 5 (39.8% male, Mage=59.01, SD=11.17). U.S. birthplace, age, and educational attainment significantly predicted HL scores, while SS did not. Cox proportional hazard models were run to assess the impact of HL on mortality of Hispanic CKD patients. HL was predictive of death (HR = .978, p<.05) and lower HL was associated with earlier mortality. In additional models including social support variables, unmarried status was approaching significance, indicating that it is also associated with increased risk of death (HR = .548, p<.05). When controlling for other mortality risk factors, older age (p=<0.05), participant sex (p= <.01), having diabetes (p= <.001), having CVD (p=<.05), and lower eGFR (p=<.05) were predictive of increased mortality risk, and marriage status- approached significance whereas HL in later models became non-significant (p= .707). Conclusion:

Our study highlights the significant impact of sociodemographic factors, including birthplace, age, and education on health literacy scores. Notably, participants born in the U.S. exhibited higher HL scores, emphasizing the need for culturally tailored interventions to bridge HL gaps among diverse populations. These findings emphasize the need for regular assessment and continued monitoring of HL and social support in Hispanic patients with chronic kidney disease as it has been shown to increase mortality risk. Future research should aim to create culturally competent tailored interventions to address the gaps in literacy within diverse populations.