Association Between Health Literacy and Prehypertension in South Korean Adults: Cross-Sectional Study Using the 2023 Korea National Health and Nutrition Examination Survey

Abstract

Background: Hypertension represents an important global health challenge, closely linked to cardiovascular diseases and elevated premature mortality rates. Prehypertension, defined as elevated blood pressure not meeting the diagnostic criteria for hypertension, necessitates early intervention to prevent disease progression. Health literacy, defined as the capacity to comprehend and use health-related information, is a key determinant of health outcomes but has rarely been studied in the context of prehypertension prevention. Objective: This study investigated the association between health literacy and prehypertension in South Korean adults. Unlike prior research focusing on treatment adherence in diagnosed patients, this study used the most recent nationally representative data to explore how domain-specific health literacy is associated with prehypertension across various subgroups, identifying potential mechanisms for intervention. Methods: Data were obtained from the 2023 Korea National Health and Nutrition Examination Survey, a nationally representative cross-sectional study. A stratified, multistage clustered sampling design was used to invite participants. Adults aged 19 years and older (N=1873) who completed the Korean Health Literacy Index were included. Prehypertension was defined as a systolic blood pressure of 130 to 139 mm Hg or a diastolic blood pressure of 80 to 89 mm Hg. A multivariable survey-weighted logistic regression model was used to assess the associations between health literacy and prehypertension, adjusting for sociodemographic and health-related covariates. Results: Of the 1873 participants, 319 (17.0%) had prehypertension, and 1098 (58.6%) showed low health literacy. After adjustment, those with low health literacy had a 43% higher likelihood of prehypertension (odds ratio 1.43, 95% CI 1.07-1.91) than those with high health literacy. Subgroup analyses revealed that the protective impact of health literacy is not uniform but is modulated by demographic contexts. Conclusions: The observed patterns may reflect three potential mechanisms: (1) motivation for and dependency on health information (eg, in women, middle-aged, lower education, and unemployed groups), (2) synergy between health literacy and resources (eg, in high-income, urban, married, and employer-insured groups), and (3) preventive efficacy in low-risk populations. Low health literacy was significantly associated with prehypertension, with variations across subgroups suggesting context-dependent mechanisms. Health literacy may serve as a modifiable determinant and compensatory resource for cardiovascular risk prevention, particularly in populations with limited access to health care. Targeted interventions that address domain-specific health literacy deficits are needed to reduce the prehypertension burden.