Surveillance for sensory impairment, activity limitation, and health-related quality of life among older adults--United States, 1993-1997.

PROBLEM/CONDITION: Increases in life expectancy in the United States are accompanied by concerns regarding the cumulative impact of chronic disease and impairments on the prevalence of disability and the health status and quality of life of the growing number of older adults (defined as persons aged > or =65 years). Although older adults are the focus of these surveillance summaries, persons aged 55-64 years have also been included, when data were available, as a comparison. One important public health goal for an aging society is to minimize the impact of chronic disease and impairments on the health status of older adults, maintain their ability to live independently, and improve their quality of life. This report examines three dimensions of health status: sensory impairments, activity limitations, and health-related quality of life among older adults. REPORTING PERIOD: This report examines data regarding activity limitations and sensory impairments for 1994 and health-related quality of life for 1993-1997. DESCRIPTION OF SYSTEM: The 1994 National Health Interview Survey (NHIS) Core, NHIS disability supplement (NHIS-D1), and the 1994 NHIS Second Supplement on Aging (SOA II) were used to estimate vision impairments, hearing loss, and activity limitation. Data from the Behavioral Risk Factor Surveillance System (BRFSS) for 1993 through 1997 were used to estimate two general measures of health-related quality of life: a) the prevalence of self-rated fair or poor general health and b) the number of days during the preceding 30 days when respondents reported their physical or mental health was "not good." RESULTS: Sensory impairments are common among older adults. Among adults aged > or =70 years, 18.1% reported vision impairments, 33.2% reported hearing impairments, and 8.6% reported both hearing and vision impairments. Although older adults who reported vision and hearing impairments reported more comorbidities than their non-hearing-impaired and nonvisually impaired peers, impaired adults with sensory loss were able to sustain valued social participation roles. Advancing age was associated with increased likelihood of difficulty in performing functional activities and instrumental and basic activities of daily living, regardless of race/ethnicity, sex, and region of residence in the United States. Unhealthy days (a continuous measure of population health-related quality of life) was consistent with self-rated health (a commonly used categorical measure) and useful in identifying subtle differences among sociodemographic groups of older adults. An important finding was that adults aged 55-64 years with low socioeconomic status (i.e., less than a high school education or an annual household income of <$15,000) reported substantially greater numbers of unhealthy days than their peers aged 65-74 years. INTERPRETATION: Sensory impairments are common in adults aged > or =70 years, and prevalence of activity limitations among older adults is high and associated with advancing age. Health-related quality of life is less closely related to age, particularly when health-related quality of life includes aspects of mental health.     

Racial/ethnic disparities in self-rated health status among adults with and without disabilities--United States, 2004-2006

Self-rated health status has been found to be an independent predictor of morbidity and mortality, and racial/ethnic disparities in self-rated health status persist among the U.S. adult population. Black and Hispanic adults are more likely to report their general health status as fair or poor compared with white adults. In addition, the prevalence of disability has been shown to be higher among blacks and American Indians/Alaska Natives (AI/ANs) (3). To estimate differences in self-rated health status by race/ethnicity and disability, CDC analyzed data from the 2004-2006 Behavioral Risk Factor Surveillance System (BRFSS) surveys. This report summarizes the results of that analysis, which indicated that the prevalence of disability among U.S. adults ranged from 11.6% among Asians to 29.9% among AI/ANs. Within each racial/ethnic population, adults with a disability were more likely to report fair or poor health than adults without a disability, with differences ranging from 16.8 percentage points among Asians to 37.9 percentage points among AI/ANs. Efforts to reduce racial/ethnic health disparities should explicitly include strategies to improve the health and well being of persons with disabilities within each racial/ethnic population.     

Worsening trends in adult health-related quality of life and self-rated health-United States, 1993-2001

OBJECTIVES: Health-related quality of life and self-rated health complement mortality and morbidity as measures used in tracking changes and disparities in population health. The objectives of this study were to determine whether and how health-related quality of life and self-rated health changed overall in U.S. adults and in specific sociodemographic and geographic groups from 1993 through 2001. METHODS: The authors analyzed data from annual cross-sectional Behavioral Risk Factor Surveillance System surveys of 1.2 million adults from randomly selected households with telephones in the 50 states and the District of Columbia. RESULTS: Mean physically and mentally unhealthy days and activity limitation days remained constant early in the study period but increased later on. Mean unhealthy days increased about 14% during the study period. The percentage with fair or poor self-rated health increased from 13.4% in 1993 to 15.5% in 2001. Health-related quality of life and self-rated health worsened in most demographic groups, especially adults 45-54 years old, high school graduates without further education, and those with annual household incomes less than $50,000. However, adults 65 years old or older and people identified as non-Hispanic Asian/Pacific Islander reported stable or improving health-related quality of life and self-rated health. In 18 of the states and the District of Columbia, mean unhealthy days increased, while only North Dakota reported a decrease. CONCLUSION: Population tracking of adult health-related quality of life and self-rated health identified worsening trends overall and for many groups, suggesting that the nation's overall health goals as identified in the Healthy People planning process are not being met.     

Health-related quality of life among adults with serious psychological distress and chronic medical conditions

Objective Determine the prevalence of serious psychological distress (SPD) among adults with and without chronic medical conditions and examine the association between SPD and health-related quality of life (HRQOL). Methods Cross-sectional data from the 2005 Los Angeles County Health Survey were used to estimate prevalence of SPD. The association between SPD and HRQOL was evaluated using logistic regression and analysis of covariance, adjusting for sociodemographic variables and number of chronic conditions. Results SPD was significantly associated with younger age, lower income, being unemployed or disabled, being unmarried, fair or poor health, and having one or more chronic conditions. Adults with three or more chronic conditions were six times as likely to have SPD as those with no conditions. Adults with SPD reported significantly more unhealthy days (mental and physical) and activity limitation days than adults without SPD. The adjusted mean number of unhealthy days was highest among adults with SPD (23.3), followed by adults with depression (14.1), and diabetes (10.6). Conclusions SPD is associated with decreased HRQOL and presence of chronic medical conditions. Mental health should be routinely assessed when addressing health needs of individuals and communities. Persons with chronic diseases may benefit from targeted mental health screening and programs that employ treatment approaches that jointly manage physical and mental health and provide improved links and access to services.     

Health-related quality of life by disease and socio-economic group in the general population in Sweden

Measuring health-related quality of life (HRQoL) on population level, is becoming increasingly important for priority setting in health policy. In the health economics field, it is common to measure HRQoL in terms of health-state utilities or QoL weights. This study investigates the feasibility of obtaining mean QoL weights by mapping survey data to the generic HRQoL measure EQ-5D and to describe the HRQoL in terms of mean QoL weights in certain disease and socio-economic groups. Data from the 1996-1997 Survey of Living Conditions, interviews with a representative sample (16-84 years) of the Swedish population (n=11 698) were used. The mean QoL weight decreased from 0.91 among the youngest to 0.61 among the oldest, and was lower for women than for men. The QoL weight was 0.88 in the highest socio-economic group and 0.78 in the lowest socio-economic group. The QoL weight was lowest (0.38) among persons with depression and highest among persons with hypertension (0.71). The QoL weight decreased from 0.95 for persons with very good global self-rated health to 0.20 for persons with very poor global self-rated health. The results support the feasibility and validity of the mapping approach. HRQoL varies greatly between socio-economic groups and different disease groups.     

Health-related quality of life among adults with work-related asthma in the United States

Purpose

The objective of this study was to examine health-related quality of life among adults with work-related asthma.

Methods

We analyzed 2006–2009 Behavioral Risk Factor Surveillance System Asthma Call-back Survey data for ever-employed adults with current asthma from 38 states and District of Columbia. Individuals with work-related asthma had been told by a doctor or other health professional that their asthma was related to any job they ever had. Health-related quality of life indicators included poor self-rated health, impaired physical health, impaired mental health, and activity limitation. We calculated prevalence ratios (PRs) adjusted for age, sex, race/ethnicity, education, income, employment, and health insurance.

Results

Of ever-employed adults with current asthma, an estimated 9.0 % had work-related asthma, 26.9 % had poor self-rated health, 20.6 % had impaired physical health, 18.2 % had impaired mental health, and 10.2 % had activity limitation. Individuals with work-related asthma were significantly more likely than those with non-work-related asthma to have poor self-rated health [PR, 1.45; 95 % confidence interval (CI), 1.31–1.60], impaired physical health (PR, 1.60; 95 % CI, 1.42–1.80), impaired mental health (PR, 1.55; 95 % CI, 1.34–1.80), and activity limitation (PR, 2.16; 95 % CI, 1.81–2.56).

Conclusions

Future research should examine opportunities to improve health-related quality of life among individuals with work-related asthma.     

The use of outpatient mental health services in the United States and Ontario: the impact of mental morbidity and perceived need for care.

OBJECTIVES: This study compared the associations of individual mental health disorders, self-rated mental health, disability, and perceived need for care with the use of outpatient mental health services in the United States and the Canadian province of Ontario. METHODS: A cross-sectional study design was employed. Data came from the 1990 US National Comorbidity Survey and the 1990 Mental Health Supplement to the Ontario Health Survey. RESULTS: The odds of receiving any medical or psychiatric specialty services were as follows: for persons with any affective disorder, 3.1 in the United States vs 11.0 in Ontario; for persons with fair or poor self-rated mental health, 2.7 in the United States vs 5.0 in Ontario; for persons with mental health-related disability. 3.0 in the United States vs 1.5 in Ontario. When perceived need was controlled for, most of the between country differences in use disappeared. CONCLUSIONS: The higher use of mental health services in the United States than in Ontario is mostly explained by the combination of a higher prevalence of mental morbidity and a higher prevalence of perceived need for care among persons with low mental morbidity in the United States.     

Health-related quality of life--Puerto Rico, 1996-2000

Although a number of studies have been made to determine the health-related quality of life (HRQOL) of persons living in the United States, no overall assessment of HRQOL has been conducted previously for residents of Puerto Rico. To determine the HRQOL of adults living in Puerto Rico, during 1996-2000, as part of the Behavioral Risk Factor Surveillance System (BRFSS), interviews were conducted in Spanish with a representative sample of Puerto Rican adults. Older women, persons with less education or lower income, persons unable to work, and those who were overweight or who had diabetes or high blood pressure reported more days for which they were physically or mentally unhealthy during the 30 days preceding the survey. Interventions designed to reach these vulnerable, demographic, socioeconomic, and behavioral risk groups might help adults in Puerto Rico increase their quality and years of healthy life and eliminate health disparities.     

Prevalence of self-reported cardiovascular disease among persons aged > or =35 years with diabetes--United States, 1997-2005

Adults with diabetes are at greater risk for dying from heart disease than adults without diabetes. Heart disease and stroke account for approximately 65% of deaths among persons with diabetes. During 1997-2005, the age-adjusted prevalence of diagnosed diabetes in the United States increased 43%, from 3.7% in 1997 to 5.3% in 2005. To assess trends in prevalence of heart disease, stroke, and other cardiovascular diseases (CVDs) among persons with diabetes, CDC analyzed data from the National Health Interview Survey (NHIS). This report summarizes the results of that assessment, which indicated that although the number of persons aged > or =35 years with diagnosed diabetes who reported having CVD increased 36% during 1997-2005, the age-adjusted prevalence decreased 11%; however, the decrease in CVD prevalence did not occur in all subpopulations with diabetes. The decrease in CVD prevalence indicates that the increase in the number of persons with diagnosed diabetes exceeded the increase in the number of persons with diagnosed diabetes who reported having a CVD. Continued interventions are needed to reduce modifiable CVD risk factors among persons with diabetes, better control diabetes, and decrease CVD prevalence further.     

Probabilities of transition among health states for older adults

Goal: To estimate the probabilities of transition among self-rated health states for older adults, and examine how they vary by age and sex. Methods: We used self-rated health (excellent, very good, good, fair, poor, dead) collected in two longitudinal studies of older adults (mean age 75) to estimate the probability of transition in 2 years. We used the estimates to project future health for selected cohorts. Findings: These older adults were most likely to be in the same health state 2 years later, but a substantial proportion changed in both directions. Transition probabilities varied by initial health state, age and sex. Men were more likely than women to transition to excellent or dead. Women were more likely than men to transition to good or fair health. Although women aged 70 will have more years of life and more years of healthy life than men, they also have more years of unhealthy life, and the proportion of remaining life that is healthy is slightly higher for men. When observed and predicted years of healthy life (YHL) were compared in various subgroups, the YHL of persons with less favorable baseline characteristics was lower than predicted, and vice-versa. Differences, however, were small (about 5%). Conclusions: These transition probability estimates can be used to predict the future health of individuals or groups as a function of current age, sex, and self-rated health. This revised version was published online in June 2006 with corrections to the Cover Date.     

Self-rated health and healthy days: examining the "disability paradox"

BackgroundThere is an important need to better understand how self-evaluations of health are reached among people with and without disabilities. The purpose of the present study was to use epidemiological data to confirm differences in self-rated health and health-related quality of life among people with and without disabilities, and to demonstrate that disability status influences how one thinks about self-rated health.MethodsSecondary analysis of cross-sectional data from the Behavioural Risk Factor Surveillance System (BRFSS). Health-related quality of life (HRQOL) core questions were asked, including self rated health, and the Healthy Days Index. Participants consisted of 303,822 adults (18 or older) from all states, the District of Columbia, and all U.S. territories who responded to the BRFSS in 2004.ResultsAdults who self-reported an activity limitation or use of adaptive equipment reported poorer self-rated health, more recent days when physical health or mental health was not good, and fewer healthy days. Within the same SRH category, people with disabilities reported significantly more recent days when physical health was not good, more days when mental health was not good, and fewer healthy days than people without disabilities.ConclusionsThe findings suggest that people with disabilities may construct health or the self-rating process differently than persons without disabilities. Further understanding of the underlying process of health and HRQOL self-assessment may help elucidate the meaning of self-rated health among adults with and without disabilities. This conceptual disentangling of health from disability is necessary to track the achievement of national health objectives.     

Self-reported body mass index and health-related quality of life: findings from the Behavioral Risk Factor Surveillance System

OBJECTIVE: To examine the relationship between self-reported body mass index (BMI) and health-related quality of life in the general adult population in the United STATES: RESEARCH METHODS AND PROCEDURES: Using data from 109,076 respondents in the 1996 Behavioral Risk Factor Surveillance System, we examined how self-reported BMI is associated with five health-related quality of life measures developed by the Centers for Disease Control and Prevention for population health surveillance. RESULTS: After adjusting for age, gender, race or ethnicity, educational attainment, employment status, smoking status, and physical activity status, participants with a self-reported BMI of <18.5 kg/m(2) and participants with a self-reported BMI of > or =30 kg/m(2) reported impaired quality of life. Compared with persons with a self-reported BMI of 18.5 to <25 kg/m(2), odds ratios (ORs) of poor or fair self-rated health increased among persons with self-reported BMIs of <18.5 (1.57, 95% confidence interval [CI]: 1.31 to 1.89), 25 to <30 kg/m(2) (1.12, 95% CI: 1.04 to 1.20), 30 to <35 kg/m(2) (1.65, 95% CI: 1.50 to 1.81), 35 to <40 kg/m(2) (2.58, 95% CI: 2.21 to 3.00), and > or =40 kg/m(2) (3.23, 95% CI: 2.63 to 3.95); ORs for reporting > or =14 days of poor physical health during the previous 30 days were 1.44 (95% CI: 1.21 to 1.72), 1.04 (95% CI: 0.96 to 1.14), 1.32 (95% CI: 1.19 to 1.47), 1.80 (95% CI: 1.52 to 2.13), and 2.37 (95% CI: 1.90 to 2.94), respectively; ORs for having > or =14 days of poor mental health during the previous 30 days were 1.18 (95% CI: 0.97 to 1.42), 1.02 (95% CI: 0.95 to 1.11), 1.22 (95% CI: 1.10 to 1.36), 1.68 (95% CI: 1.42 to 1.98), and 1.66 (95% CI: 1.32 to 2.09), respectively. DISCUSSION: In the largest study to date, low and increased self-reported BMI significantly impaired health-related quality of life. Particularly, deviations from normal BMI affected physical functioning more strongly than mental functioning.     

Self-rated health and associated factors in adults: a population survey in Rio Branco, Acre State, Brazil, 2007-2008

The subjective concept of health included in the self-rated health process allows identifying factors associated with good self-rated health in populations. This cross-sectional population-based study in 2007-2008 focused on self-rated health and associated factors among adults (n = 1,516) in Rio Branco, Acre State, Brazil. The multivariate analysis used Poisson regression, with fair/poor self-rated health as the dependent variable. Differences in gender, age group, level of schooling, and income negatively affected individuals' self-rated health. After adjusting for age, gender, and self-reported illness, the estimated risks for fair/poor health were higher for the unemployed, obese, and those with some self-reported illness. The results suggest that differences in living conditions for adults in Rio Branco are associated with precarious self-rated health.     

Association Between Time Homeless and Perceived Health Status Among The Homeless in San Francisco

The purpose of this study was to describe the perceived health of the homeless, and to measure the effect of time homeless on perceived health status, after controlling for sociodemographic characteristics and health conditions. The design was cross-sectional; the population was a representative sample of homeless in San Francisco, interviewed on health issues. Analysis of predictors of poor or fair health status was by logistic regression. In this sample of 2780 persons, 37.4% reported that their health status was poor or fair as compared to good or excellent. Reporting poor or fair health status was significantly associated with time homeless, after controlling for sociodemographic variables and health problems including results from screening for HIV and TB (OR = 1.49, 95%CI 1.24–1.79). Comparisons with data from the National Health Interview Survey (NHIS) showed poorer health status among the homeless persons in this study. Standardized morbidity ratios were highest for asthma; there was twice the number of homeless persons reporting asthma, in younger as well as older adults, as would be expected using NHIS rates. There was also an excess of arthritis, high blood pressure and diabetes in those age 18–44 as compared to adults in the Health Interview Survey. The time spent homeless remains associated with self-reported health status, after known contributors to poor health are controlled. Persons who have been homeless for longer periods of time may be the persons to whom health care interventions should be aimed.     

Metabolic syndrome and health-related quality of life among U.S. adults

PURPOSE: Little is known about the association between health-related quality of life and the metabolic syndrome. The objective of this study was to compare health-related quality of life in adults with and without the metabolic syndrome. METHODS: We performed a cross-sectional analysis of 1859 men and women aged > or =20 years from the National Health and Nutrition Examination Survey 2001-2002. Health-related quality of life was assessed with the Centers for Disease Control and Prevention HRQOL-4 tool. RESULTS: A larger percentage of participants with the metabolic syndrome had fair or poor health (difference = 11.3%, p = 0.002), > or =14 physically unhealthy days (difference = 5.0%) (p = 0.129), > or =14 mentally unhealthy days (difference = 7.4%) (p = 0.010), and > or =14 activity-limitation days (difference = 5.8%) (p = 0.024) during the past 30 days than participants without the metabolic syndrome. After adjusting for age, sex, ethnicity, educational status, and smoking status, participants with the metabolic syndrome were more likely to have fair or poor health (odds ratio [OR], 1.94; 95% confidence interval [CI], 1.21-3.13), > or =14 mentally unhealthy days (OR, 1.97; 95% CI, 1.28-3.02), and > or =14 activity limitation days (OR, 3.20; 95% CI, 1.46-7.02) than those without the metabolic syndrome. CONCLUSIONS: U.S. adults with the metabolic syndrome experience worse health-related quality of life than adults without this syndrome.     

U.S. state-level social capital and health-related quality of life: multilevel evidence of main, mediating, and modifying effects

PURPOSE: The aim of this study was to investigate the relation between state-level social capital and adult health-related quality of life (HRQOL) in the United States. METHODS: Using data from the 2001 Behavioral Risk Factor Surveillance System survey and other surveys and administrative sources, we conducted a two-level, multivariable analysis of 173,236 adults in 48 U.S. states to estimate the associations of state-level social capital (along two scales) with individual-level self-rated general health and the numbers of recent days of poor physical health, poor mental health, and activity limitation. RESULTS: For each social capital scale, living in a state intermediate or high (vs. low) in social capital was each associated with 10% to 11% lower odds of fair/poor health. Higher state-level social capital also predicted fewer recent days of poor physical and mental health and activity limitation. Differential returns of social capital to HRQOL according to state-level mean income and individual-level age and race/ethnicity were observed. Furthermore, evidence was found compatible with mediation by social capital of income inequality effects on HRQOL. CONCLUSIONS: This study yields new evidence consistent with protective effects of state-level social capital on individual HRQOL. Promoting social capital may provide a means of improving the health-related quality of life of Americans.     

Health-related quality of life assessment by the EuroQol-5D in some rural adults]

OBJECTIVES: The purposes of this study were to examine the health-related quality of life(HRQoL) and to identify its related factors for a group of rural adults. METHODS: The study subjects were 1,901 adults who were aged 40-70 years and who were living in Naju City, Jeollanamdo. The sociodemographic characteristics, health-related behavior, health status and global self-rated health were collected for statistical analysis. The health related quality of life was measured by the Euroqol EQ-5D instrument. The differences on the EQ-5D index between the groups were assessed with t-test, ANOVA and hierarchical multiple regression analysis. RESULTS: Overall, the mean value of the EQ-5D index was 0.884 +/- 0.140 and this score was significantly different according to the socioeconomic characteristics, the health related behavior, the health status and the global self-rated health. According to the results from the hierarchical multiple regression analysis, the HRQoL was significantly reduced for females, older subjects, and other subjects with no spouse and the subjects with osteoporosis, obesity, mental distress or poorer global self-rated health. CONCLUSIONS: The HRQoL for rural adults was related to the socioeconomic characteristics, the health status and the global self-rated health. A better understanding of the factors related to the HRQoL would help to improve the rural adults' quality of life.     

State-specific prevalence of obesity among adults with disabilities--eight states and the District of Columbia, 1998-1999

The national health objectives for 2010 rank obesity among the top ten leading health indicators. Obesity increases the risk for type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease, respiratory problems, certain cancers, gallstones, osteoarthritis, and lowered life expectancy. The estimated annual cost attributable to obesity-related diseases is approximately $100 billion. Obesity among adults in the general U. S. population increased from 12.0% in 1991 to 17.9% in 1998. Little is known about the national or state prevalence of obesity among persons with disabilities. Obesity is not measured routinely or reported among persons with disabilities. To determine the prevalence of obesity among persons with and without disabilities, CDC analyzed data from the 1998 and 1999 Behavioral Risk Factor Surveillance System (BRFSS) for eight states and the District of Columbia (DC). The findings indicate that obesity rates are significantly higher among persons with disabilities, especially among blacks and persons aged 45-64 years. The findings suggest that public health messages and interventions should be targeted to persons with disabilities who are likely to become obese and to obese persons who are likely to become disabled.     

The Associations Between Life Satisfaction and Health-related Quality of Life, Chronic Illness, and Health Behaviors among U.S. Community-dwelling Adults

The primary purpose of this article was to examine the associations between life satisfaction level and health-related quality of life (HRQOL), chronic illness, and adverse health behaviors among adults in the U.S. and its territories. Data were obtained from the 2005 Behavioral Risk Factor Surveillance System, an ongoing, state-based, random-digit telephone survey of the noninstitutionalized U.S. population aged ≥18 years. An estimated 5.6% of U.S. adults (about 12 million) reported that they were dissatisfied/very dissatisfied with their lives. As the level of life satisfaction decreased, the prevalence of fair/poor general health, disability, and infrequent social support increased as did the mean number of days in the past 30 days of physical distress, mental distress, activity limitation, depressive symptoms, anxiety symptoms, sleep insufficiency, and pain. The prevalence of smoking, obesity, physical inactivity, and heavy drinking also increased with decreasing level of life satisfaction. Moreover, adults with chronic illnesses were significantly more likely than those without to report life dissatisfaction. Notably, all of these associations remained significant after adjusting for sociodemographic characteristics. Our findings showed that HRQOL and health risk behaviors varied with level of life satisfaction. As life satisfaction appears to encompass many individual life domains, it may be an important concept for public health research. Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.     

The Contribution of Health Literacy to Disparities in Self-Rated Health Status and Preventive Health Behaviors in Older Adults

PURPOSE Health literacy is associated with a range of poor health-related outcomes. Evidence that health literacy contributes to disparities in health is minimal and based on brief screening instruments that have limited ability to assess health literacy. The purpose of this study was to assess whether health literacy contributes, through mediation, to racial/ethnic and education-related disparities in self-rated health status and preventive health behaviors among older adults.METHODS We undertook a cross-sectional study of a nationally representative sample of 2,668 US adults aged 65 years and older from the 2003 National Assessment of Adult Literacy. Multiple regression analysis was used to assess for evidence of mediation.RESULTS Of older adults in the United States, 29% reported fair or poor health status, and 27% to 39% reported not utilizing 3 recommended preventive health care services in the year preceding the assessment (influenza vaccination 27%, mammography 34%, dental checkup 39%). Health literacy and the 4 health outcomes (self-rated health status and utilization of the 3 preventive health care services) varied by race/ethnicity and educational attainment. Regression analyses indicated that, after controlling for potential confounders, health literacy significantly mediated both racial/ethnic and education-related disparities in self-rated health status and receipt of influenza vaccination, but only education-related disparities in receipt of mammography and dental care.CONCLUSIONS Health literacy contributes to disparities associated with race/ethnicity and educational attainment in self-rated health and some preventive health behaviors among older adults. Interventions addressing low health literacy may reduce these disparities.