• Justin Rodgers, Sujay Kakarmath, Vanessa Denis, Marta Encinas-Martin, and S V Subramanian.
• Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA 02138, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
• Prev Med. 2019 Dec 1; 129: 105872.

AbstractThe association between numeracy proficiency and health outcomes has been the subject of several studies. However, it is not known if this association is independent of educational attainment and literacy proficiency. In this study, we used logistic regression to model numeracy proficiency as a predictor of self-rated poor health after accounting for educational attainment and literacy proficiency. The prevalence of self-rated poor health among 166,863 adults aged 16-65 years from 33 high- and upper middle-income countries was 24%. Compared to those with the highest numeracy proficiency (level 4), the odds ratio of self-rated poor health for those with the lowest numeracy proficiency (level 1) was 2.2 (95% CI 1.9-2.7) and attenuated to 1.8 (95% CI 1.5-2.1) and 1.5 (95% CI 1.1, 2.0), respectively, after sequential addition of self-education and literacy proficiency. For those who were assessed to have low levels of both numeracy and literacy proficiency, the odds ratio of self-rated poor health was 1.4 (95% CI 1.3 to 1.5), relative to those who had high levels of both numeracy and literacy proficiencies. Numeracy and literacy proficiencies show both independent and interdependent correlations with poor self-rated health. Further, these associations varied by sociodemographic characteristics and across countries. Policies aimed at improving numeracy and literacy may be beneficial in preventing adverse health outcomes.Copyright © 2019 Elsevier Inc. All rights reserved.

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