Neurocognitive performance differences between black and white individuals with HIV disease are mediated by health literacy

ABSTRACT

Objective:

Health disparities are evident for Black Americans with HIV disease, who are disproportionally affected by the epidemic in the United States. The current study investigated whether the higher rates of neurocognitive impairment in Black Americans with HIV disease may be at least partly attributable to health literacy, which is a potentially modifiable factor. Method: Participants were 61 White and 25 Black participants (ages 27-70) with HIV disease who were enrolled in studies at an urban academic center in Southern California. Neurocognitive function was assessed by an age-adjusted global score from the Cogstate battery. Health literacy was measured by a composite score derived from the Rapid Estimate of Adult Literacy in Medicine, Newest Vital Sign, and 3-Brief. Results: Bootstrap confidence interval mediation analyses showed that health literacy was a significant mediator of the relationship between race and neurocognition; that is, there were no direct ethnoracial differences in neurocognition after accounting for health literacy. A follow-up model to confirm the directionality of this association demonstrated that neurocognition was not a significant mediator of the relationship between race and health literacy. Conclusions: Low health literacy may contribute to the higher rates of neurocognitive impairment for Black Americans with HIV disease. Future studies might examine the possible mechanism of this mediating relationship (e.g., access to health information, health behaviors, socioeconomics) and determine whether culturally tailored interventions that improve health literacy also confer broader brain health benefits for Black Americans with HIV disease.

KEYWORDS:

• Health disparities
• neurocognitive disorders
• race and ethnicity
• cultural psychology
• health psychology
• neuropsychological assessment

Acknowledgements

The authors would like to thank the UC San Diego HIV Neurobehavioral Research Program (HNRP) Group (I. Grant, PI) for their infrastructure support of the parent grants. We would especially like to thank Donald Franklin, Dr. Erin Morgan, Clint Cushman, and Stephanie Corkran for their assistance with data processing, Marizela Verduzco for her assistance with study management, Dr. Scott Letendre and Dr. Ronald J. Ellis for their assistance with the neuromedical aspects of the parent project, and Dr. J. Hampton Atkinson and Jennifer Marquie Beck for their assistance with participant recruitment and retention. The views written in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, nor the United States Government. The authors would also like to thank the study volunteers for their participation.

This article was co-authored by Dr. Steven Paul Woods, who is an Associate Editor for The Clinical Neuropsychologist and the Co-Editor of this special issue. As per Taylor & Francis policy, and in compliance with publishing ethics, Dr. Woods did not have access to any aspects of the review process pertaining to this article. Drs. Yana Suchy (TCN’s Editor-in-Chief) and Marc Norman (Co-Editor of this special issue) assumed 100% responsibility for the processing and editorial decisions regarding this manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the National Institutes of Health under grants R01-MH073419, R21-MH098607, and P30-MH62512.