Association between literacy and self-rated poor health in 33 high- and upper middle-income countries

Sujay Kakarmath, Vanessa Denis, Marta Encinas-Martin, Francesca Borgonovi, S. V. Subramanian

To assess the relationship between general literacy proficiency and self-rated poor health by analyzing data from the Programme for the International Assessment of Adult Competencies, an international survey conducted from 2011 to 2015 in 33 high- and upper middle-income countries and national sub-regions. Logistic regression was used to model general literacy proficiency as a predictor of self-rated poor health. Data from 167,062 adults aged 25-65 years were analyzed. The mean overall prevalence of self-rated poor health was 24%. The odds ratio of self-rated poor health for those in the lowest level of general literacy proficiency compared to those in the highest level was 2.5 (95% CI 2.2-3.0) in the unadjusted model, and 1.9 (95% CI 1.6-2.2) in the adjusted model. This association was robust over time and across countries. General literacy proficiency attenuated 22% of the effect of self-education on self-rated poor health, in addition to a substantial independent effect of its own. Our study provides robust and generalizable evidence that general literacy proficiency is independently associated with self-rated poor health. These results offer a potential modifiable target for policy interventions to reduce educational inequities in health.