Presentations

Abstract

Introduction:

Health care for hemodialysis patients depends on understanding and interpreting quantitative data reflecting health status, risk, and prognosis. Few studies exist evaluating the role of health numeracy. In this study, we aim to identify characteristics associated with low health numeracy and determine its association with health outcomes among patients receiving in-center hemodialysis for end-stage kidney disease. We hypothesize that low numeracy in hemodialysis patients is associated with an increased risk for poor health outcomes.

Methods:

The Dialysis Outcomes and Practice Patterns Study (DOPPS) is an international prospective cohort study of a representative sample of hemodialysis patients. Health numeracy was scored using a validated 3-item version of the Subjective Numeracy Scale (SNS-3) where higher scores (range 3-18) indicated higher numeracy skills. Regression models adjusting for potential confounding variables evaluated the associations between numeracy score and health outcomes including mortality, hospitalization, and vascular access.

Results:

Among 5104 hemodialysis patients, 46% had low health numeracy. Lower numeracy scores were associated with fewer years of education, lower health literacy, unemployment, a diagnosis of diabetes, and female gender. Compared to high numeracy, low numeracy was associated with increased odds of catheter access use (Odds Ratio 1.30, 95% CI: [1.15, 1.50]) as well as an increased rate of all- cause hospitalization events (Rate Ratio 1.25, 95% CI: [1.05, 1.35]) in the fully adjusted model. Although low numeracy also demonstrated a higher risk of all-cause mortality (Hazard Ratio 1.30 (95% CI: [0.99, 1.50]), it did not reach statistical significance.

Conclusion:

In this large international cohort of patients receiving hemodialysis, lower health numeracy was associated with increased risk for important health outcomes including all-cause hospitalization and catheter use for vascular access. This study identifies health communication involving numeracy may be a key modifiable mechanism to improve these health outcomes as well as address related health disparities.