Association Between Limited English Proficiency and Healthcare Access and Utilization in California

Gulati, Reeti K.; Hur, Kevin

doi:10.1007/s10903-021-01224-5

Cited by 36 publications

(24 citation statements)

References 22 publications

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“…Numerous studies have documented significant health disparities in patients with LEP, including access to care [17][18][19] and health outcomes in routine practice. [14][15][16] In the research setting, prior work based in Australia has reported that culturally and linguistically diverse patients (defined as being born in non-English-speaking countries) were less likely to participate in cancer clinical trials than those born in English-speaking countries; additionally, the subgroup of diverse patients whose preferred language was not English were least likely to participate in clinical trials, with an odds ratio of 0.45.…”

Section: Discussionmentioning

confidence: 99%

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Participation of Patients With Limited English Proficiency in Gynecologic Oncology Clinical Trials

Jorge

Masshoor

Gray

et al. 2023

Journal of the National Comprehensive Cancer Network

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Background: Significant disparities exist in recruitment of minorities to clinical trials, with much of the prior literature focused on race/ethnicity only. Limited English proficiency (LEP) is a known barrier in healthcare that may also drive disparities in trial enrollment. We sought to determine participation rates in gynecologic oncology trials among patients with LEP and to explore barriers to their participation. Methods: In a retrospective cohort study, electronic health record data from >2,700 patients treated over 2 years at one academic gynecologic oncology practice were abstracted and the primary exposure of having LEP was identified. The primary outcome was enrollment in a clinical trial. Demographic, financial, clinical, and healthcare access–related covariates were also abstracted and considered as potential confounders in a multivariable logistic regression model. Age, race, ethnicity, and insurance status were further examined for evidence of effect modification. In addition, a survey was administered to all gynecologic oncology research staff and gynecologic oncology providers (n=25) to assess barriers to research participation among patients with LEP. Results: Clinical trial enrollment was 7.5% among fluent English speakers and 2.2% among patients with LEP (risk ratio, 0.29; 95% CI, 0.11–0.78; P=.007), and remained significantly lower in patients with LEP after adjusting for the identified confounders of Hispanic ethnicity and insurance payer (odds ratio, 0.34; 95% CI, 0.12–0.97; P=.043). There was a trend toward race and LEP interaction: Asian patients were equally likely to participate in research regardless of language fluency, whereas White and Black patients with LEP were less likely to participate than non-LEP patients in both groups (P=.07). Providers reported that the most significant barriers to enrollment of patients with LEP in research were unavailability of translated consent forms and increased time needed to enroll patients. Conclusions: Patients with LEP were 3.4 times less likely to participate in gynecologic oncology trials than fluent English speakers. De-aggregation of race, ethnicity, and language proficiency yielded important information about enrollment disparities. These findings offer avenues for future interventions to correct disparities.

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Section: Discussionmentioning

confidence: 99%

“…[11][12][13] However, the underlying mechanisms are not fully understood. Limited English proficiency (LEP) is a known barrier in healthcare [14][15][16][17][18][19] that may drive other disparities in trial enrollment. Individuals with LEP constitute 8.6% of the US population and represent the full spectrum of race and ethnic categories.…”

Section: Introductionmentioning

confidence: 99%

Participation of Patients With Limited English Proficiency in Gynecologic Oncology Clinical Trials

Jorge

Masshoor

Gray

et al. 2023

Journal of the National Comprehensive Cancer Network

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“…Living in poverty, as many farmworkers do, is a major barrier to healthy food access, as it forces one to make difficult choices between meeting other basic needs such as housing costs or medical care and food. Language and low education are barriers to accessing medical care, as individuals with limited English proficiency in California are less likely to have access to preventative care (69). Although most farmworkers speak Spanish, there is a small proportion who speak different indigenous languages (3), making the language barrier a hard one to address.…”

Section: High Total Cholesterolmentioning

confidence: 99%

Chronic disease burden among Latino farmworkers in California

Matias

Gomez-Lara²,

Schenker³

2022

Front. Public Health

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Farmworkers are an essential workforce to maintain California's extensive agricultural production. However, this mostly Latino, immigrant population is affected by high poverty rates and food insecurity, which increases their risk of chronic diseases. We analyzed clinical and interview data from three studies of Latino farmworkers in California: (1) the Mexican Immigration to California: Agricultural Safety and Acculturation (MICASA) study, (2) the PASOS SALUDABLES pilot intervention (PASOS Pilot), and (3) the PASOS Study, a cluster-randomized, controlled trial (PASOS RCT). We aimed to determine the prevalence of diet-related chronic health outcomes (obesity, elevated waist circumference, high blood pressure, and high total cholesterol) and identify sociodemographic and socioeconomic factors associated with these conditions in this population. A total of 1,300 participants were included in this study (452 from MICASA, 248 from PASOS Pilot, and 600 from PASOS RCT). Obesity prevalence ranged from 29.2 to 54.5% across samples; elevated waist circumference was observed in 29.4–54.0% of participants; high blood pressure was detected in 42.0–45.5% of participants; 23.7–25.8% of participants had high total cholesterol. Age was positively associated with each health outcome, although not for each sample; each additional year in age increased odds by 3–9%, depending on the outcome and sample. Females were at higher risk of obesity (one sample) and elevated waist circumference, but at lower risk of high blood pressure and high total cholesterol. Single, divorced or widowed participants (vs. married/living together) had 35 and 47% reduced odds of obesity and elevated waist circumference, respectively. Each additional year living in the US was associated with 3–6% increased odds of obesity, depending on the sample. Higher household income was associated with a reduction in odds of high total cholesterol up to 76% (one sample). These findings highlight the increased risk of chronic health conditions in Latino farmworkers, in particular for obesity, and among farmworkers who may lack access to health care, which represents a large proportion of this population. Differences in chronic health risks by sex suggest that clinical and public health responses might need to be sex-specific. Expansion of eligibility for supplemental nutrition programs for this low-income population could reduce their disease burden.

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“…Linguistic minority groups are vulnerable to epistemic injustice—the communicative contextual disadvantage within which power asymmetries and language discordance affects the exchange of health information . Patients with limited English proficiency (LEP) are less likely to have a clinical home or to have received preventive care in the prior year, even after adjusting for sociodemographic factors . In the US context, LPOE and LEP are associated with worse health outcomes …”

Section: Introductionmentioning

confidence: 99%

Evaluation of Preferred Language and Timing of COVID-19 Vaccine Uptake and Disease Outcomes

et al. 2023

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ImportanceBeyond traditional race and ethnicity demographic characteristics, additional discrete data variables are needed for informed health interventions in the US.ObjectiveTo examine whether COVID-19 vaccine uptake patterns and associated disease outcomes differ among language preference groups.Design, Setting, and ParticipantsA cohort study of 851 410 individuals aged 18 years or older in a large multispecialty health system in Minnesota and western Wisconsin was conducted between December 15, 2020, and March 31, 2022.ExposureSelf-identified language preference and limited English proficiency (LEP) as measured by interpreter need were used to create subgroups using US census categories and attention to capture languages known to represent refugee groups.Main Outcomes and MeasuresThe primary outcome was COVID-19 vaccination uptake rates and time to first vaccine. Secondary outcomes were rates of COVID-19–associated hospitalization and death.ResultsMost of the 851 410 participants (women, 493 910 [58.0%]; median age, 29 [IQR, 35-64] years) were US-born English speakers; 7.5% were born in other countries, 4.0% had a language preference other than English (LPOE), and 3.0% indicated LEP as measured by interpreter need. Marked temporal clusters were observed for COVID-19 vaccination uptake, hospitalizations, and deaths associated with primary series vaccine eligibility, booster availability, and COVID-19 variants. Delayed first-dose vaccine was observed with LPOE (hazard ratio [HR], 0.83; 95% CI, 0.82-0.84) and interpreter need (HR, 0.81; 95% CI, 0.80-0.82) compared with those with English language preference and proficiency. Patients with LPOE were approximately twice as likely to be hospitalized (rate ratio [RR], 1.85; 95% CI, 1.63-2.08) or die (RR, 2.13; 95% CI, 1.65-2.69). Patients with LEP experienced even higher rates of hospitalization (RR, 1.98; 95% CI, 1.73-2.25) and COVID-19–associated death (RR, 2.32; 95% CI, 1.79-2.95). Outcomes varied for individual language preference groups.Conclusions and RelevanceIn this study, delayed time to first-dose vaccine was associated with increased COVID-19 hospitalization and death rates for specific LPOE and LEP groups. The findings suggest that data collection of language preference and interpreter need provides actionable health intervention information. Standardized system-level data collection, including at a national level, may improve efficient identification of social groups with disproportionate health disparities and provide key information on improving health equity in the US.

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Association Between Limited English Proficiency and Healthcare Access and Utilization in California

Cited by 36 publications

References 22 publications

Participation of Patients With Limited English Proficiency in Gynecologic Oncology Clinical Trials

Participation of Patients With Limited English Proficiency in Gynecologic Oncology Clinical Trials

Chronic disease burden among Latino farmworkers in California

Evaluation of Preferred Language and Timing of COVID-19 Vaccine Uptake and Disease Outcomes

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