Association between health literacy and multimorbidity: a nationwide, cross-sectional study of a Japanese population

Objectives To examine the relationship between health literacy and multimorbidity. Design Nationwide cross-sectional study. Setting Community settings across Japan. Participants Community-dwelling participants aged 20 years or older were selected based on a quota sampling method that adjusted for age, sex and residential area. In total, 3678 participants from the Health Diary Study, with a mean age of 52.3 years (SD, 18.2 years; 1943 (52.8%) female participants), were included. Primary outcome measure Multimorbidity, the primary outcome measure, was defined as the presence of two or more chronic diseases. Results Of the 3678 participants, 824 (22.4%) had multimorbidity. The mean functional health literacy (FHL) and communicative and critical health literacy (CCHL) scores were 3.2 (SD, 0.7) and 3.6 (SD, 0.9), respectively. In the univariable analysis, both scores were associated with multimorbidity (p<0.001). However, in the multivariable modified Poisson regression analysis, only the FHL score was significantly associated with multimorbidity (per 1-point increase, 0.91; 95% CI 0.84 to 0.99). Conclusions After adjusting for confounding variables, FHL, not CCHL, was significantly related to the presence of multimorbidity. Further longitudinal studies are required to examine the causal relationship between health literacy and multimorbidity.