Cross-sectional study of 942 middle-aged primary care patients (age 35–64, mean 52 years) in Chicago evaluated the prevalence of limited health literacy using the Newest Vital Sign, health self-management skills using the CHAS-SF, and self-reported physical function using PROMIS-PF.
13.2% had low health literacy and 19.3% had marginal health literacy. In adjusted models, low health literacy was strongly linked to worse self-management (β = −15.5; 95% CI: −19.7 to −11.2; p < 0.001) and marginal health literacy also predicted worse self-management (β = −8.4; 95% CI: −11.6 to −5.0; p < 0.001). However, health literacy was **not** independently associated with physical function after adjusting for covariates (low: β = −0.3, p = 0.75; marginal: β = −1.1, p = 0.13).
- Single urban site (Chicago) with English-only participants limits generalizability. - Self-selection bias likely: active primary care patients may underrepresent those with the lowest health literacy. - Cross-sectional design prevents causal inference; longitudinal follow-up is ongoing.
About 1 in 3 middle-aged primary care patients showed limited health literacy, and these patients performed meaningfully worse on real-world medication dosing and health information tasks — even after adjusting for education and income. Routine health literacy screening and plain-language communication tools should not be reserved for older adults; middle adulthood is a key window for intervention.
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