Health Literacy Mediates Racial Differences in Cognitive Functioning among African American/Black and White People with and without HIV in the Deep South.

Purpose: Disparities in cognition among middle-aged and older African American/Black adults are evident, especially among people living with HIV (PLWH). Though disparities in health literacy among African American/Black adults impact health outcomes across clinical populations, its role in racial differences in cognition among PLWH is not well understood. This study aimed to determine if health literacy mediated racial differences in cognition among PLWH and people living without HIV (PLWoH). Patients and methods: Measures of oral word literacy (Wide Range Achievement Test-3rd Edition), health literacy (Test of Functional Literacy in Adults - Reading Comprehension subtest, Rapid Estimate of Adult Literacy in Medicine, Newest Vital Sign, Expanded Numeracy Scale), and cognition (gold standard neurocognitive battery) were examined in 273 participants (170 PLWH: 86% African American/Black; 103 PLWoH: 65% African American/Black) via secondary analysis. Multivariable linear regressions (MLRs) among PLWH and PLWoH examined associations between health literacy and cognition, accounting for relevant covariates, followed by adjusted bootstrap confidence interval mediation analyses to determine whether health literacy mediated the association between race and cognition. Results: In both samples, White people scored higher than African American/Black people on measures of cognition, health literacy, oral word literacy, and SES. Adjusted MLRs in PLWH and PLWoH separately showed health literacy was associated with cognition (PLWH: b = .205, p = .007; PLWoH: b = 0.354, p = .002). Health literacy significantly mediated the association between race and cognition, independent of covariates (PLWH: effect = .055, 95% CI [0.0048, 0.1973]; PLWoH: effect = .093, 95% CI [0.0276, 0.1827]). Conclusion: These results underscore the importance of health literacy in explaining racial disparities in cognition among African American/Black PLWH and PLWoH in the Deep South. Findings have implications for guiding the development of health literacy interventions, which may have downstream positive impacts on cognition.