Low Health Literacy Among IBD Population More Common in Older Black Persons

A team of investigators evaluated the prevalence of and sought to identify risk factors associated with low health literacy in a diverse population of individuals with inflammatory bowel disease.

Older Black persons with inflammatory bowel disease (IBD) may be an increased risk for low health literacy, according to the results of a study published in Crohns Colitis 360. For this reason, addressing racial disparities in the treatment of Black individuals has the potential to provide benefit for the overall management of patients with IBD.

A team of investigators conducted a study at a tertiary-referral IBD center in Alabama between November 2017 and May 2018, in which they evaluated adult patients with IBD for health literacy using the Newest Vital Sign (NVS). The NVS is frequently used to evaluate health literacy in a surgical population. The investigators also collected demographic and socioeconomic data from study participants.

The objective of the study was to assess low health literacy among a diverse population of individuals with IBD and identify likely factors linked to low health literacy. The prevalence of low health literacy was the primary study outcome, and secondary outcomes included length of stay and 30-day readmissions after surgical encounters. The analysis comprised bivariate comparisons and multivariable regression.

A total of 175 patients with IBD enrolled in the study: 59% were women, 23% were Black, 91% had Crohn disease, and mean age was 46±16.7 years. The researchers found that 24% of participants in the study had low health literacy according to the NVS. In comparison with White patients with IBD, the prevalence of low health literacy for Black patients was significantly higher (47.5% vs 17%). In addition, multivariable analysis revealed that low health literacy was linked to older age and Black race.

This study was limited by inclusion of data from a single tertiary-referral IBD center, selection biases, possibility of type 2 error in relation to clinical outcomes, the inclusion of a limited number of patients with ulcerative colitis in the study, secondary outcomes there were not specific to IBD, and low survey response rate among patients with low health literacy.

Nevertheless, the researchers determined a significant relationship between older Black persons with IBD and low health literacy. These findings highlight the importance of reducing racial disparities in the care of patients with IBD.


Santos Marques ICD, Theiss LM, Baker SJ, et al. Low health literacy exists in the inflammatory bowel disease (IBD) population and is disproportionately prevalent in older African Americans. Crohns Colitis 360. 2020;2(4):otaa076. doi:10.1093/crocol/otaa076