Changing trend in health literacy about chronic disease prevention and treatment among Chinese residents, 2012 – 2017: an age-period-cohort analysis

  Objective  To analyze changing trend and in health literacy about chronic disease prevention (HLCDP) and its associated factors among 15 – 69 years old residents in China from 2012 to 2017 for providing references to the promotion of HLCDP in the population.

  Methods  Using simple random sampling, we extracted the data on 89 153 urban and rural residents aged 15 – 69 years from the dataset of National Health Literacy Surveillance conducted yearly from 2012 to 2017 across China. A multi-level fixed effect model was constructed using hierarcal age-period-cohort (APC) method to explore changing trend in HLCDP and its associates.

  Results  For the years from 2012 to 2017, the proportion of the residents with HLCDP were 8.52%, 11.01%, 9.01%, 10.05%, 10.25%, and 13.96%, respectively, with an overall upward trend (χ² = 118.69, P < 0.001). Similar changing trends in net and crude period effect on HLCDP were observed, with a fluctuation from 2012 to 2016 and a rapid increase between 2016 and 2017. After adjusting for demographic factors and health status, the results of multi-level fixed effect model analysis showed that the residents with the education of primary school and above, being medical staff and having a better self-perceived health status were more likely to have a higher HLCDP; while, the residents being ethnic minorities, being farmers or workers, living in central or western regions or in rural areas were more likely to have a lower HLCDP. Significantly increased proportion of the residents having HLCDP were observed in 2013, 2015 and 2017 compared to that in corresponding previous one year, with the odds ratios of 1.200,1.116 and 1.535 (all P < 0.01). The period effect on the variation of HLCDP was significant, but the age-effect or the cohort-effect were not significant (both P > 0.05).

  Conclusion  Among Chinese residents, the net period effect on HLCDP increased generally from 2012 to 2017 and the effect was greater for the period from 2016 to 2017. Attention should be paid to the impact of period effect and some demographic factors on changing trend of HLCDP.