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Risk of Death Greater With Low Literacy Levels

death rate was 20 percent. Among all others, the death rate was 11 percent. After taking into account gender, race, socioeconomic status, education, health status, health care access, and health-related behaviors, the authors concluded that limited literacy increased the risk of death by a factor of 1.75.

Only two other factors had a stronger association with mortality, according to the study. Self-reported poor health increased mortality risk 2.17 times (Sudore notes that self-reported health status is a robust measure of actual health). Being a current smoker increased the risk of death 3.09 times.

Given the observational nature of the study, says Sudore, the researchers could not ascertain why low literacy increased the risk of death. She offers a number of possible reasons, including a link between illiteracy and poverty.

"Many studies have shown that people with lower socioeconomic status have higher mortality rates," she notes. "It could be that people with limited literacy have fewer economic opportunities, lower paying jobs, and lower socioeconomic status overall. There may have been socioeconomic factors and combined lifetime effects of lower socioeconomic status that we could not assess in this study."

In addition, says Sudore, "limited literacy might be the result of poorly controlled chronic disease over time - that is, your disease burden is so high that it interferes with cognitive processing."

Finally, she adds, "Our health care system places high literacy demands on patients, so limited literacy likely impedes access to health care and chronic disease management. Poor understanding of how to take medication or how to manage chronic disease, not to mention being unable to navigate through the complex health care system, could also cause increased mortality."

Sudore warns that low literacy might have profound implications for public health. "The elderly population is growing,
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