Health literacy and health care utilization among older people in Sweden

Background

Strong demands are set on health care systems as a result of an ageing population. Health literacy (HL), an individuals’ capacity to understand and use information regarding health, has been suggested to be linked with health care utilization. The main aim of this study is to investigate the association between HL and health care utilization among older people in Sweden.

Methods

This is a nationally representative, community-based study using a cross-sectional design with 18 months longitudinal follow-up of health care utilization. It was conducted in Sweden and included adults aged 77 + participating in the 2021 wave of the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD). Participants were sampled from the general population and interviewed primarily by telephone. HL was assessed using the validated Communicative and Critical HL scale and categorized in 3 groups. Three measures of health care utilization were used: self-reported refraining from seeking needed care, emergency care visits, and avoidable hospital admissions. Emergency visits and avoidable admissions were obtained from the Swedish National Patient Register. Associations between HL and outcomes were examined using logistic regression with both crude and adjusted models using population weights.

Results

Preliminary analyses showed an increased OR between HL and to refrain from care (OR = 2,1 95% C.I. 1,1-3,9) and being admitted for a diagnosis which is considered avoidable (OR = 3,0 95% C.I. 1,3-6,8) between the group with sufficient vs inadequate HL. No association between HL and visit to the emergency care was found. In the full adjusted model, no significant associations remained.

Conclusions

Our findings suggests that in a Swedish context, there is no link between HL and certain measures of health care utilization among older people. However, further studies investigating the link between HL and other measures are needed.

Key messages

• Health literacy is not consistently related to healthcare utilization among older adults in Sweden.

• Further studies are needed to understand the role of health literacy in healthcare utilization among older adults.