PO.PS01.10 · 人群科学
美国成年人健康素养和癌症病史与医疗信任之间的关联
Association between health literacy and cancer history with medical trust among adults in the United States
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
引言：健康素养，即理解健康信息的能力，塑造了寻求健康的行为。在有癌症病史的人群中，低健康素养与不良结局相关。在一个虚假信息盛行的时代，考察健康素养和癌症病史如何与对健康信息来源的信任相互作用，可以阐明个体的健康决策。
方法：我们分析了健康信息全国趋势调查（HINTS）的数据——一个具有全国代表性的数据集——涵盖2014、2018、2020、2022和2024年周期。考察了健康素养（低：从不、很少、有时；高：总是）、个人癌症病史（曾患对从未患）和年龄（18–39岁、40–64岁、65岁及以上）与对医生、家人和宗教组织提供健康信息的信任（低：完全不、一点、一些；高：非常）之间的关系。所有变量均为自我报告。采用调查加权的logistic回归模型，在R中使用刀切法（jackknife）考虑复杂抽样和重复权重。模型纳入健康素养、癌症病史、年龄类别和调查周期作为预测变量。使用Rao-Scott似然比检验检验年龄与健康素养、年龄与癌症病史之间的交互作用；对显著的交互作用采用分层比值比进一步探讨。
结果：较高的健康素养与对医生提供健康信息的更高信任显著相关（aOR 4.50，95% CI 3.61–5.60）。按年龄分层时，该关联有所不同（18–39岁：aOR 4.78，95% CI 2.89–7.91；40–64岁：aOR 4.00，95% CI 2.91–5.50；65岁及以上：aOR 5.34，95% CI 3.68–7.75）。癌症病史与对医生的信任无关（aOR 1.17，95% CI 0.91–1.51），且信任在各周期间无明显差异。对于对家人提供健康信息的信任，其与健康素养的关联因年龄而异（交互作用p = 0.03）。在分层分析中，较高的健康素养在较年轻成年人中显示出信任更高的趋势（18–39岁：aOR 2.02，95% CI 0.91–4.51），而在中年（40–64岁：aOR 0.71，95% CI 0.43–1.16）和老年成年人（65岁及以上：aOR 1.02，95% CI 0.56–1.87）中关联较弱。癌症病史与对家人的信任无关，但在较晚周期中信任较低（2022年对2017年 aOR 0.58，95% CI 0.42–0.81；2024年对2014年 aOR 0.56，95% CI 0.41–0.76），提示COVID-19大流行后对家人的信任发生转变。对宗教组织提供健康信息的信任在老年成年人中较高（40–64岁对18–39岁 aOR：1.95，95% CI 1.36–2.79；65岁及以上对18–39岁 aOR：1.55，95% CI 1.13–2.15），在癌症生存者中较低（aOR 0.61，95% CI 0.43–0.87）。健康素养与对宗教组织的信任无关，且信任在各周期间保持稳定。
结论：这些发现强调了针对不同患者和信任情境开展针对性外展的重要性，以促进知情的健康决策，尤其是针对老年成年人和癌症生存者。
查看英文原文 English abstract
Introduction: Health literacy, or the ability to understand health information, shapes health-seeking behaviors. Among those with a history of cancer, low health literacy is associated with poor outcomes. In an era of disinformation, examining how health literacy and cancer history interact with trust in sources of health information can elucidate individuals' health decisions.
Methods: We analyzed data from the Health Information National Trends Survey (HINTS), a nationally representative dataset, for the 2014, 2018, 2020, 2022, and 2024 cycles. Health literacy (Low: never, rarely, sometimes; High: always), personal cancer history (ever vs. never), and age (18-39, 40-64, 65+) were examined in relation to trust in doctors, family, and religious organizations for health information (Low: not at all, a little, some; High: a lot). All variables were self-reported. Survey-weighted logistic regression models accounted for complex sampling and replicate weights using the jackknife method in R. Models included health literacy, cancer history, age category, and survey cycle as predictors. Interactions between age and health literacy, and age and cancer history were tested using Rao-Scott likelihood ratio tests; significant interactions were explored with stratified odds ratios.
Results: Higher health literacy was significantly associated with greater trust in doctors for health information (aOR 4.50, 95% CI 3.61-5.60). When stratified by age, the association varied (ages 18-39: aOR 4.78, 95% CI 2.89-7.91; ages 40-64: aOR 4.00, 95% CI 2.91-5.50; ages 65+: aOR 5.34, 95% CI 3.68-7.75). Cancer history was not associated with doctor trust (aOR 1.17, 95% CI 0.91-1.51), and trust did not vary meaningfully by cycle. For trust in family for health information, the association with health literacy differed by age (interaction p = 0.03). In stratified analyses, higher health literacy showed a trend towards greater trust among younger adults (ages 18-39: aOR 2.02, 95% CI 0.91-4.51), while associations were weaker for middle-aged (ages 40-64: aOR 0.71, 95% CI 0.43-1.16) and older adults (65+: aOR 1.02, 95% CI 0.56-1.87). Cancer history was not associated with family trust, but trust was lower in later cycles (2022 vs. 2017 aOR 0.58, 95% CI 0.42-0.81; 2024 vs. 2014 AOR 0.56, 95% CI 0.41-0.76), suggesting shifting trust in family after the COVID-19 pandemic. Trust in religious organizations for health information was higher in older adults (ages 40-64 vs. 18-39 aOR: 1.95, 95% CI 1.36-2.79; 65+ vs. 18-39 aOR: 1.55, 95% CI 1.13-2.15) and lower among cancer survivors (aOR 0.61, 95% CI 0.43-0.87). Health literacy was not associated with trust in religious organizations and trust remained stable across cycles.
Conclusion: These findings emphasize the importance of targeted outreach for different patient and trust contexts to promote informed health decisions, especially for older adults and cancer survivors.
利益披露 Disclosure
H. Haque, None.