The association between health literacy and preventable hospitalizations in Missouri: implications in an era of reform.

OBJECTIVE To evaluate the association between health literacy and preventable hospitalizations on a population level in Missouri, and the extent to which differing levels of health literacy are associated with county preventable hospitalization rates and associated charges. DATA SOURCES/STUDY SETTING Secondary data from the 2008 Missouri Information for Community Assessment and Missouri Health Literacy Mapping Tool was used to determine health literacy and preventable hospitalization rates for the 114 counties and city of St. Louis comprising Missouri. STUDY DESIGN Using correlation analysis, simple hierarchical regression models and nonparametric analysis, we investigated whether lower health literacy rates were associated with increased levels of preventable hospitalizations and charges, by county. PRINCIPAL FINDINGS Health literacy was found to be inversely associated with preventable hospitalization rates on a population level, accounting for 21 percent of the variation in preventable hospitalization rates. Preventable hospitalization rates significantly differed for counties with the highest and lowest health literacy levels. CONCLUSIONS Lower levels of health literacy are significantly associated with increased rates of preventable hospitalizations and charges in a population-level analysis of Missouri counties. Additional research is needed to quantify the effects of successful community health literacy interventions.