Coronavirus disease 2019 (COVID-19) has disproportionately affected Latinx communities across the United States. Latinx and African American individuals have 3 times the infection rate and twice the mortality rate from COVID-19 compared with White individuals. 1 Latinx individuals are overrepresented as essential workers, which has contributed to their increased risk of contracting COVID-19 and experiencing related complications. 2 Additional factors likely contribute to poor Latinx health outcomes, including institutional racism, discrimination, health care access, and socioeconomic and documentation status. 3 As of 2019, the US population is 16.9% Latinx, of which 16.1% speak Spanish and do not speak English well. 4 Many hospitals have implemented programs to improve accessibility of services to diverse populations. However, translation continues to be inadequate in addressing language barriers preventing Latinx communities from seeking appropriate care. 5 Particularly, patients are deprived of important information about hospitals due to a paucity of Spanish translation of hospital websites. Our cross-sectional study aims to elucidate this issue by investigating potential variables associated with Spanish translation of hospital websites. MethodsThis cross-sectional study did not involve human participants and, therefore, did not require ethical review under 45 CFR part 46. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.A list of 30 top adult hospitals and 10 top children's hospitals in the US was compiled from the US News Weekly & World Report and Newsweek. This list represents a snapshot of US health care, which consists of 637 total health systems, of which 54 contain at least one children's hospital. 6 Hospitals were classified as affiliated or not affiliated with a public medical school. Hospital websites were reviewed between June 29 and August 3, 2020. Websites were assessed for containing policies on Immigration and Customs Enforcement (ICE) activities on hospital grounds. The dependent variable was whether or not hospital websites had real-time Spanish translation capabilities, further categorized as using Google Translate or other translation methods. The 2018 American Community Survey Demographic and Housing Estimates were used to determine percentage of Latinx population in hospital counties. A threshold of P < .05 in logistic regression was used to determine statistical significance of variables on the binary outcome of a hospital website being available in Spanish. Odds ratios were calculated by exponentiating the coefficients of the logistic regression.Statistical analysis was performed using R statistical software version 1.2.5033 (R Project for Statistical Computing) from July to September 2020. ResultsOf the 40 hospitals studied, nine (22.5%) had Spanish translation capabilities. Of those, 2 used Google Translate, whereas translation methods of the others are unknown. No hospital had explicit documentation of human tra...

Previous research has demonstrated that undocumented Latinx immigrants in the USA report worse physical health outcomes than documented immigrants. Some studies suggest that immigration-related stress and healthcare related-stress may explain this relationship, but none have tested it empirically. The purpose of this study was to determine if immigration-related stress and healthcare-related stress in the USA explain the relationship between documentation status and physical health among Latinx immigrants in North Carolina. The conceptual model was tested utilizing baseline data from a longitudinal, observational, community-engaged research study of young adult (18-44 years) Latinx immigrants residing in North Carolina (N = 391). Structural equation modeling was used to determine relationships among documentation status, healthcare, and immigration stress in the past six months, and self-rated physical health. Goodness-of-fit measures indicated that data fit the model well (RMSEA = .008; CFI = 1.0; TLI = .999; SRMR = .02; CD = .157). Undocumented individuals were more likely to experience immigration stress than their documented counterparts ( = − 0.37, p < 0.001). Both immigration stress ( = − 0.22, p < 0.01) and healthcare stress ( = − 0.14, p < 0.05) were negatively related to physical health. Additionally, immigration stress was positively related to healthcare stress ( = 0.72, p < 0.001). Results demonstrate that documentation status is an important social determinant of health. Passage of inclusive immigration and healthcare policies may lessen the stress experienced by Latinx immigrants and subsequently improve physical health.