{"doi":"10.1093/ndt/gfac201","title":"Prospective associations of health literacy with clinical outcomes in adults with CKD: findings from the CRIC study","abstract":"BACKGROUND: Limited health literacy is associated with significant morbidity and mortality in the general population but the relation of health literacy with long-term clinical outcomes among adults with chronic kidney disease (CKD) is less clear. METHODS: Prospective data from the Chronic Renal Insufficiency Cohort (CRIC) Study (n = 3715) were used. Health literacy was assessed with the Short Test of Functional Health Literacy in Adults (dichotomized as limited/adequate). Cox proportional hazards models were used to separately examine the relations of health literacy with CKD progression, cardiovascular event (any of the following: myocardial infarction, congestive heart failure, stroke or peripheral artery disease), and all-cause, cardiovascular and non-cardiovascular mortality. Poisson regression was used to assess the health literacy-hospitalization association. Models were sequentially adjusted: Model 1 adjusted for potential confounders (sociodemographic factors), while Model 2 additionally adjusted for potential mediators (clinical and lifestyle factors) of the associations of interest. RESULTS: In confounder-adjusted models, participants with limited (vs adequate) health literacy [555 (15%)] had an increased risk of CKD progression [hazard ratio (HR) 1.34; 95% confidence interval (CI) 1.06-1.71], cardiovascular event (HR 1.67; 95% CI 1.39-2.00), hospitalization (rate ratio 1.33; 95% CI 1.26-1.40), and all-cause (HR 1.54; 95% CI 1.27-1.86), cardiovascular (HR 2.39; 95% CI 1.69-3.38) and non-cardiovascular (HR 1.27; 95% CI 1.01-1.60) mortality. Additional adjustments for potential mediators (Model 2) showed similar results except that the relations of health literacy with CKD progression and non-cardiovascular mortality were no longer statistically significant. CONCLUSIONS: In the CRIC Study, adults with limited (vs adequate) health literacy had a higher risk for CKD progression, cardiovascular event, hospitalization and mortality-regardless of adjustment for potential confounders.","journal":"Nephrology Dialysis Transplantation","year":2022,"id":272876,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":11,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.6776,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":429613,"name":"Paula Allen‐Meares","orcid":null,"position":1,"is_corresponding":false},{"id":348121,"name":"Ana C. Ricardo","orcid":"0000-0001-8670-3644","position":2,"is_corresponding":false},{"id":281086,"name":"Michael J. Fischer","orcid":"0009-0001-1713-9741","position":3,"is_corresponding":false},{"id":404153,"name":"Elisa J. Gordon","orcid":"0000-0003-0969-1998","position":4,"is_corresponding":false},{"id":939820,"name":"Eunice Carmona-Powell","orcid":null,"position":5,"is_corresponding":false},{"id":337716,"name":"James Sondheimer","orcid":"0000-0002-9538-9682","position":6,"is_corresponding":false},{"id":261903,"name":"Jing Chen","orcid":"0000-0002-9035-9126","position":7,"is_corresponding":false},{"id":506130,"name":"Edward Horwitz","orcid":"0000-0003-2287-6954","position":8,"is_corresponding":false},{"id":939457,"name":"Xue Wang","orcid":"0000-0002-0371-4004","position":9,"is_corresponding":false},{"id":337715,"name":"Jesse Y. Hsu","orcid":"0000-0002-1522-6534","position":10,"is_corresponding":false},{"id":277166,"name":"James P. Lash","orcid":"0000-0002-6580-4080","position":11,"is_corresponding":false},{"id":277165,"name":"Claudia M. Lora","orcid":"0009-0004-7546-144X","position":12,"is_corresponding":false},{"id":283357,"name":"the CRIC Study Investigators","orcid":null,"position":13,"is_corresponding":false},{"id":277163,"name":"Lawrence J. Appel","orcid":"0000-0002-0673-6823","position":14,"is_corresponding":false},{"id":939458,"name":"Jing Chen","orcid":"0000-0001-9156-8600","position":15,"is_corresponding":false},{"id":58429,"name":"Harold I. Feldman","orcid":"0000-0003-4572-2608","position":16,"is_corresponding":false},{"id":249669,"name":"Alan S. Go","orcid":"0000-0001-9109-0811","position":17,"is_corresponding":false},{"id":68431,"name":"Robert G. Nelson","orcid":"0000-0001-7307-3786","position":18,"is_corresponding":false},{"id":277171,"name":"Mahboob Rahman","orcid":"0000-0001-9025-7413","position":19,"is_corresponding":false},{"id":277170,"name":"Panduranga S. Rao","orcid":"0000-0002-4699-5395","position":20,"is_corresponding":false},{"id":277172,"name":"Vallabh O. Shah","orcid":"0000-0002-3584-4057","position":21,"is_corresponding":false},{"id":232678,"name":"Raymond R. Townsend","orcid":"0000-0002-3215-9118","position":22,"is_corresponding":false},{"id":277173,"name":"Mark L. Unruh","orcid":"0000-0001-7103-656X","position":23,"is_corresponding":false},{"id":428973,"name":"Mayra L. Estrella","orcid":"0000-0002-6649-8898","position":0,"is_corresponding":true}],"reference_count":40,"raw_metadata":null,"created_at":"2026-07-19T00:27:47.926496Z","pmid":"35746879","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}