Abstract P127: Health Literacy and COVID-19 Infection and Vaccination: The C4R-MESA Study

Rationale: Health literacy (HL) is associated with health prevention behaviors and may influence COVID-19 outcomes. Objective: To test associations of HL, risk of COVID-19 infection, and receipt of COVID-19 vaccines in a multi-ethnic US community-based sample. Methods: The Multi-Ethnic Study of Atherosclerosis (MESA) assessed participant levels of HL via follow-up phone calls in year 18 (2016-18), as well as the impact of the COVID-19 pandemic via questionnaires designed by the Collaborative Cohort of Cohorts for COVID-19 Research (C4R) Study (2020-23). The 4 HL items asked about difficulty in the ability to read, comprehend, and complete medical materials and understand medical statistics (scales 1-5, low to high difficulty); scores were summed and dichotomized into adequate (≤10) or low (>10) HL. COVID-19 data included infection and vaccination status and time (days) until infection and vaccination (March 2020-February 2023). Unadjusted comparisons of COVID-19 data and HL were assessed by Chi-square and T-tests. Cox proportional hazards models were adjusted for age, sex, race/ethnicity, and then additionally for income and education. Results: Of 3412 participants (mean age 77 years; 54% female; 41% White, 13% Chinese, 26% Black 20% Hispanic), 409 (12%) had low HL and 360 (11%) had incident COVID-19 infections. In the subset with vaccination data (N=1781), 94% were vaccinated. While HL was not significantly associated with incident COVID-19 infection, low (vs adequate) HL was significantly associated with longer time-to-vaccination and lower adjusted hazards of vaccination ( Table ). Conclusions: Our findings suggest that low levels of HL are associated with delayed COVID-19 vaccination, even after accounting for demographic and socioeconomic indicators. Improving health literacy in the population may empower and encourage individuals to engage in disease prevention behaviors, including vaccination. Table: Associations of Health Literacy (HL) with COVID-19 Infection and Vaccination