Trends in health literacy levels among residents of Anhui Province from 2021 to 2024 and its association with medical out-of-pocket expenses

XIE Jianrong; FU Yuansheng; XU De; WANG Zhimin; XIA Yuanrui; FAN Yinguang

doi:10.16462/j.cnki.zhjbkz.2025.08.009

Volume 29 Issue 8

Aug. 2025

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XIE Jianrong, FU Yuansheng, XU De, WANG Zhimin, XIA Yuanrui, FAN Yinguang. Trends in health literacy levels among residents of Anhui Province from 2021 to 2024 and its association with medical out-of-pocket expenses[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2025, 29(8): 922-929. doi: 10.16462/j.cnki.zhjbkz.2025.08.009

Citation:

XIE Jianrong, FU Yuansheng, XU De, WANG Zhimin, XIA Yuanrui, FAN Yinguang. Trends in health literacy levels among residents of Anhui Province from 2021 to 2024 and its association with medical out-of-pocket expenses[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2025, 29(8): 922-929. doi: 10.16462/j.cnki.zhjbkz.2025.08.009

Citation:

XIE Jianrong, FU Yuansheng, XU De, WANG Zhimin, XIA Yuanrui, FAN Yinguang. Trends in health literacy levels among residents of Anhui Province from 2021 to 2024 and its association with medical out-of-pocket expenses[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2025, 29(8): 922-929. doi: 10.16462/j.cnki.zhjbkz.2025.08.009

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Trends in health literacy levels among residents of Anhui Province from 2021 to 2024 and its association with medical out-of-pocket expenses

doi: 10.16462/j.cnki.zhjbkz.2025.08.009

1.
Department of Health Education, Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China
2.
Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, China

Funds:

Research Funds of Center for Big Data and Population Health of IHM JKS2022003

More Information

Corresponding author: FAN Yinguang, E-mail: fanyinguang@163.com
Received Date: 2025-04-14
Rev Recd Date: 2025-05-15
Publish Date: 2025-08-10

Abstract

Abstract

Objective To analyze the trend in health literacy levels among residents in Anhui Province from 2021 to 2024 and its correlation with medical out-of-pocket expenses, providing a basis for optimizing health promotion strategies. Methods A stratified multi-stage sampling method combined with simple random sampling and probability proportional to size (PPS) sampling was applied to conduct a health literacy survey among permanent residents aged 15-69 in Anhui Province during 2021-2024. After excluding individuals with chronic diseases, univariate and multivariate logistic regression models were used to analyze the association between health literacy and medical out-of-pocket expenses. Results Health literacy levels among residents in Anhui Province from 2021 to 2024 were 27.31%, 29.06%, 31.09% and 32.55%, respectively, showing an increasing trend (trend χ² =114.576, P < 0.001). The results of the multivariate logistic regression model analysis showed that, after controlling for confounding variables, compared with the group with limited health literacy, the group with adequate health literacy had lower medical out-of-pocket expenses (OR=0.90, 95% CI: 0.86-0.96), presenting a negative association between health literacy level and medical out-of-pocket expenses. Among the different dimensions of health literacy, three aspects of health literacy were negatively associated with medical out-of-pocket expenses (all P < 0.05). Among the six categories of health issue literacy, scientific views of health, basic medical care, and health information were also negatively associated with medical out-of-pocket expenses (all P < 0.05). Conclusions From 2021 to 2024, the health literacy levels among residents in Anhui Province has steadily improved, but there is still a gap compared to developed provinces. Medical out-of-pocket expenses are a key factor affecting the level of health literacy among residents, and insufficient health literacy is often accompanied by higher medical burdens.
- Health literacy,
- Medical out-of-pocket expenses,
- Trend of change

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References(20)

References

[1]	U.S. National library of medicine[EB/OL]. (2020-01-20)[2025-03-20]. https://medlineplus.gov/healthliteracy.html.
[2]	Hai YY, Wu WL, Yu LW, et al. Health literacy and health outcomes in China's floating population: mediating effects of health service[J]. BMC Public Health, 2021, 21(1): 691. DOI: 10.1186/s12889-021-10662-7.
[3]	Ma TP, Meng HD, Ye ZQ, et al. Health literacy mediates the association between socioeconomic status and productive aging among elderly Chinese adults in a newly urbanized community[J]. Front Public Health, 2021, 9: 647230. DOI: 10.3389/fpubh.2021.647230.
[4]	GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet, 2020, 396(10258): 1204-1222. DOI: 10.1016/S0140-6736(20)30925-9.
[5]	Li YY, Lyu XF, Liang J, et al. The development and progress of health literacy in China[J]. Front Public Health, 2022, 10: 1034907. DOI: 10.3389/fpubh.2022.1034907.
[6]	Eichler K, Wieser S, Brügger U. The costs of limited health literacy: a systematic review[J]. Int J Public Health, 2009, 54(5): 313-324. DOI: 10.1007/s00038-009-0058-2.
[7]	李英华. 2012年中国居民健康素养监测方案简介[J]. 中国健康教育, 2014, 30(6): 563-5. DOI: 10.16168/j.cnki.issn.1002-9982.2014.06.003. Li YH. Introduction of 2012 Chinese residents health literacy monitoring program[J]. Chinese Journal of Health Education, 2014, 30(6): 563-5. DOI: 10.16168/j.cnki.issn.1002-9982.2014.06.003.
[8]	国家统计局. 中国居民及重点人群健康素养监测统计调查制度[EB/OL]. (2022-03-03)[2025-03-02]. https://www.stats.gov.cn/fw/bmdcxmsp/bmzd/202302/t20230215_1907197.html.
[9]	国家卫生计生委办公厅. 《中国公民健康素养——基本知识与技能(2015年版)》[EB/OL]. (2016-01-06)[2025-03-20]. https://www.nhc.gov.cn/xcs/c100123/201601/ca65ae770b254900a6cee62f5a2d6f84.shtml.
[10]	Li L, Li YH, Nie XQ, et al. The association between health literacy and medical out-of-pocket expenses among residents in China[J]. J Public Health, 2024, 32(4): 621-629. DOI: 10.1007/s10389-022-01792-2.
[11]	安徽省卫生健康委员会. 安徽省人民政府关于印发健康安徽行动实施方案的通知[EB/OL]. (2020-01-13)[2025-03-20]. https://wjw.ah.gov.cn/ztzl/shylwstzgg/gjzc1/51991241.html.
[12]	上海市健康促进中心. 2024年上海居民健康素养水平达42.09%, 实现17年连升[EB/OL]. (2025-01-16)[2025-03-20]. https://www.schp.sh.cn/xwzx/mtsd/2948.
[13]	浙江发布. 2024年浙江居民健康素养水平结果公布[EB/OL]. (2025-02-08)[2025-03-20]. https://zjic.zj.gov.cn/ywdh/shjs/202501/t20250126_23212104.shtml.
[14]	刘亚欣, 刘虹妍, 沈阳, 等. 2012―2016年重庆市居民健康素养趋势性及其影响因素[J]. 中华疾病控制杂志, 2020, 24(8): 929-933. DOI: 10.16462/j.cnki.zhjbkz.2020.08.013. Liu YX, Liu HY, Shen Y, et al. Study on the trend of health literacy and its influencing factors in Chongqing, 2012-2016[J]. Chin J Dis Control Prev, 2020, 24(8): 929-933. DOI: 10.16462/j.cnki.zhjbkz.2020.08.013.
[15]	王莉莉, 孙乐成, 高颖, 等. 2019―2022年海南省居民健康素养水平变化情况及其影响因素分析[J]. 中国健康教育, 2024, 40(1): 45-50. DOI: 10.16168/j.cnki.issn.1002-9982.2024.01.009. Wang LL, Sun LC, Gao Y, et al. Analysis on the change of health literacy level and its influencing factors among residents in Hainan Province from 2019 to 2022[J]. Chinese Journal of Health Education, 2024, 40(1): 45-50. DOI: 10.16168/j.cnki.issn.1002-9982.2024.01.009.
[16]	姚丁铭, 吴青青, 徐水洋, 等. 2016―2020年浙江省居民健康素养水平变化趋势研究[J]. 中国预防医学杂志, 2023, 24(2): 150-155. DOI: 10.16506/j.1009-6639.2023.02.011. Yao DM, Wu QQ, Xu SY, et al. The trend of health literacy among residents in Zhejiang, 2016-2020[J]. Chin Prev Med, 2023, 24(2): 150-155. DOI: 10.16506/j.1009-6639.2023.02.011.
[17]	Rasu RS, Bawa WA, Suminski R, et al. Health literacy impact on national healthcare utilization and expenditure[J]. Int J Health Policy Manag, 2015, 4(11): 747-755. DOI: 10.15171/ijhpm.2015.151.
[18]	Haun JN, Patel NR, French DD, et al. Association between health literacy and medical care costs in an integrated healthcare system: a regional population based study[J]. BMC Health Serv Res, 2015, 15: 249. DOI: 10.1186/s12913-015-0887-z.
[19]	Mantwill S, Schulz PJ. Low health literacy associated with higher medication costs in patients with type 2 diabetes mellitus: evidence from matched survey and health insurance data[J]. Patient Educ Couns, 2015: S0738-3991(15)30015-X. DOI: 10.1016/j.pec.2015.07.006.
[20]	朱小林, 郭馨月, 陈颖, 等. 安徽省桐城市综合医院门诊患者健康素养现状及其影响因素研究[J]. 安徽预防医学杂志, 2024, 30(4): 285-290. DOI: 10.19837/j.cnki.ahyt.2024.04.006. Zhu XL, Guo XY, Chen Y, et al. Health literacy status and influencing factors of outpatients in Tongcheng general hospital of Anhui Province[J]. Anhui J Prev Med, 2024, 30(4): 285-290. DOI: 10.19837/j.cnki.ahyt.2024.04.006.