Journal Article

Do health literacy, physical health and past rehabilitation utilization explain educational differences in the subjective need for medical rehabilitation? Results of the lidA cohort study

Schröder, Chloé Charlotte, Rohrbacher, Max, Breckenkamp, Jürgen, Prel, Jean-Baptist du

2024

Overview

Background Medical rehabilitation can be helpful for maintaining workers’ health and work ability. Its contribution to longer working lives is of high economic relevance in aging populations. In Germany, individuals must apply for rehabilitative measures themselves. Therefore, the subjective need for rehabilitation (SNR) is a prerequisite for rehabilitation access. A low education level is associated with poor health, lower health literacy and more frequent utilization of health services. In the present study, we investigated whether lower educational levels are also associated with a greater SNR and whether health literacy, past rehabilitation utilization and physical health play a mediating role in this path in older employees. Methods 3,130 socially insured older employees (born in 1959 or 1965) who participated in the German prospective lidA (leben in der Arbeit) cohort-study in 2011, 2014 and 2018 were included. A causal mediation analysis with an inverse odds weighting approach was performed with the SNR as the dependent variable; educational level as the independent variable; and health, health literacy and past rehabilitation utilization as the mediating variables. Sociodemographic variables were adjusted for. Results The SNR was significantly greater in subjects with a low education level, poor physical health, inadequate health literacy and those who had utilized rehabilitation in the past. For health literacy, past rehabilitation utilization and physical health, a significant partial mediating effect on the SNR was found for employees with low compared to those with high education levels. However, the combined mediating effect of all the mediators was lower than the sum of their individual effects. Among those with medium or high education levels, none of the variables constituted a significant mediator. Conclusions The path between a low education level and a high SNR is mediated by inadequate health literacy, past rehabilitation utilization and poor physical health; these factors do not act independently of each other. Promoting health education may lower the SNR by improving physical health and health literacy. While improving physical health is beneficial for individuals, improved health literacy can be economically advantageous for the health system by reducing inappropriate expectations of rehabilitation benefits and subsequent applications for rehabilitation.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Academic achievement / Aging / Analysis / Biostatistics / Causal mediation / Chronic illnesses / Cohort analysis / Cohort Studies / Dependent variables / Education / Educational attainment / Educational Status / Employees / Environmental Health / Epidemiology / Exercise / Female / Germany / Health aspects / Health care policy / Health education / Health literacy / Health Literacy - statistics & numerical data / Health promotion / Health services / Health services utilization / Health Status / Humans / Inappropriateness / Independent variables / Influence / Investigations / Labor force / Literacy / Low income groups / Male / Mediation / Medical care / Medical personnel / Medicine / Medicine & Public Health / Middle Aged / Older people / Pain / Participation / Past rehabilitation utilization / Patient Acceptance of Health Care - psychology / Patient Acceptance of Health Care - statistics & numerical data / Physical education / Population studies / Prospective Studies / Public Health / Public health literacy / Rehabilitation / Rehabilitation - statistics & numerical data / Sociodemographics / Subjective health / Subjective need for rehabilitation / Utilization / Vaccine / Variables / Weighting / Work