Disparities in Screening for Colorectal Cancer Based on Limited Language Proficiency

Abstract

Background This study analyzes the association between limited language proficiency and screening for colorectal cancer. Methods This is a retrospective cohort study from the 2015 sample of the National Health Interview Survey database utilizing univariate and multivariate regression analysis. The study population includes subjects between 50 and 75 years of age. The main outcome analyzed was rates of screening colonoscopies between limited English-language proficiency (LEP) subjects and those fluent in English. Secondary outcomes included analysis of baseline, socioeconomic, access to health care variables, and other modalities for colorectal cancer screening between the groups. Results Incidence of limited language proficiency was 4.8% (n = 1978, count = 4 453 599). They reported lower rates of screening colonoscopies (61% vs 34%, P < .001), less physician recommendation for a colonoscopy (87 vs 60%, P < .001), fewer polyps removed in the previous 3 years (24% vs 9.1%; P < .001), and fewer fecal occult blood samples overall (P < .001). Additionally, Hispanic non-LEP subjects have higher rates of colonoscopies compared to those with language barriers (50% vs 33%, P < .001). On multivariate analysis, LEP was associated with a lower likelihood to have a screening colonoscopy (OR .67 95% CI .49-.91). A second regression model with “Spanish language” and “other language” variables included, associated Spanish speakers with a lower likelihood for a screening colonoscopy (OR .71 95% CI .52-.97) when controlling for baseline, socioeconomic, and access to health care covariates. Discussion Patients with limited English-language proficiency are associated with lower rates of screening for colorectal cancer, in particular the Spanish speaking subgroup.

Limited English proficiency and reported receipt of colorectal cancer screening among adults 45–75 in 2019 and 2021

“…Prior studies found CRC screening to range from 34 to 43 percent in adults with LEP between 2014 and 2016 ( Cataneo et al, 2022 , Ramirez et al, 2023 ). Similarly, we found 31.6 % of adults 45–75 with LEP (40.5 % of those aged 50–75 with LEP) to be up-to-date with CRC screening, suggesting that screening has not risen in adults with LEP in the past 7 years.…”

“…Adults with LEP are known to have less access to health care services ( Ponce et al, 2006 , Gulati and Hur, 2022 ), lower quality of care ( Karliner et al, 2012 , John-Baptiste et al, 2004 , Lindholm et al, 2012 ), and report worse dissatisfaction with care ( Pippins et al, 2007 , Weech-Maldonado et al, 2003 ). In 2015, 34 % of US adults with LEP reported ever having a screening colonoscopy ( Cataneo et al, 2022 ), while 43 % were up-to-date with CRC screening as of 2016 compared to 61 % of those without LEP ( Ramirez et al, 2023 ). Adults with LEP may be less likely to be screened due to difficulty communicating with their clinicians ( Berdahl and Kirby, 2019 ) and less access to preventive healthcare ( Ramirez et al, 2023 , DuBard and Gizlice, 2008 ).…”

Who, where, when: Colorectal cancer disparities by race and ethnicity, subsite, and stage

“…Lack of knowledge about CRC and CRC screening modalities, lack of physician's recommendation for screening, fear of the screening process, fear of results, cancer fatalism, and distrust of the medical system have also been identified as powerful predictors of low CRC screening adherence in API and other minority populations 35‐37 . English language proficiency and knowledge of US healthcare systems are additional barriers to CRC screening in Asian and Hispanic immigrant groups 38 . Lack of culturally appropriate cancer education resources, unintended bias exercised by providers, discrimination and structural racism experienced by patients are also likely key contributors to the observed differences in CRC burden among minority groups.…”

The Impact of Patients' Primary Language on Inpatient Gastrointestinal Bleeding Outcomes

“…Language-based disparities have been described in various domains of health care. Cataneo et al (10), using the National Health Interview Survey, showed that patients with limited English proficiency (particularly those who identified as Hispanic) had lower rates of fecal occult blood sampling for colorectal cancer screening, lower rates of physician recommendation for colonoscopy, and lower rates of receiving screening colonoscopies. In the emergency department, Spanish-speaking patients have been shown to receive lower acuity triage scores using the Emergency Severity Index compared with English-speaking patients (11).…”