Language Barriers, Physician-Patient Language Concordance, and Glycemic Control Among Insured Latinos with Diabetes: The Diabetes Study of Northern California (DISTANCE)

Abstract

BACKGROUNDA significant proportion of US Latinos with diabetes have limited English proficiency (LEP). Whether language barriers in health care contribute to poor glycemic control is unknown.OBJECTIVETo assess the association between limited English proficiency (LEP) and glycemic control and whether this association is modified by having a language-concordant physician.DESIGNCross-sectional, observational study using data from the 2005–2006 Diabetes Study of Northern California (DISTANCE). Patients received care in a managed care setting with interpreter services and self-reported their English language ability and the Spanish language ability of their physician. Outcome was poor glycemic control (glycosylated hemoglobin A1c > 9%).KEY RESULTSThe unadjusted percentage of patients with poor glycemic control was similar among Latino patients with LEP (n = 510) and Latino English-speakers (n = 2,683), and higher in both groups than in whites (n = 3,545) (21% vs 18% vs. 10%, p < 0.005). This relationship differed significantly by patient-provider language concordance (p < 0.01 for interaction). LEP patients with language-discordant physicians (n = 115) were more likely than LEP patients with language-concordant physicians (n = 137) to have poor glycemic control (27.8% vs 16.1% p = 0.02). After controlling for potential demographic and clinical confounders, LEP Latinos with language-concordant physicians had similar odds of poor glycemic control as Latino English speakers (OR 0.89; CI 0.53–1.49), whereas LEP Latinos with language-discordant physicians had greater odds of poor control than Latino English speakers (OR 1.76; CI 1.04–2.97). Among LEP Latinos, having a language discordant physician was associated with significantly poorer glycemic control (OR 1.98; CI 1.03–3.80).CONCLUSIONSLanguage barriers contribute to health disparities among Latinos with diabetes. Limited English proficiency is an independent predictor for poor glycemic control among insured US Latinos with diabetes, an association not observed when care is provided by language-concordant physicians. Future research should determine if strategies to increase language-concordant care improve glycemic control among US Latinos with LEP.

Navigating Language Barriers: A Systematic Review of Patient Navigators’ Impact on Cancer Screening for Limited English Proficient Patients

“…1 LEP persons have difficulty reading, writing and understanding English, 3 which creates obstacles to participation in the English-language dominant healthcare system. Language barriers play a significant role in poor health processes and outcomes, [4][5][6][7] including reduced accessing of preventive services 8,9 and cancer screening rates among LEP patients. [10][11][12][13] These obstacles to cancer screenings for LEP patients can be reduced with language assistance.…”

Impact of Language Barriers on Complications and Mortality Among Immigrants With Diabetes: A Population-Based Cohort Study

“…First, although a large proportion of our immigrants originated from the East Asia and Pacific region and South Asia, our cohort was quite diverse in age, period of immigration, immigration class, languages spoken, and ethnicities. Previous studies that have found language barriers to be associated with worse outcomes were demonstrated mostly among Spanish-speaking immigrants in the U.S. (12,24,27,28). It is therefore possible that the effect of language barriers varies among different ethnicities and cultural groups.…”

“…Previous studies have shown that immigrants with languageconcordant physicians have improved glycemic control and outcomes compared with those without (24,28). Family members who can act as translators may serve a similar role.…”

“…Although self-reported language barriers are often used to measure language barriers (13,14,24,25), other unmeasured variables may possibly affect how immigrants answer this question when they complete their immigration application. For example, principal applicants from the economic class are required to demonstrate language ability to be eligible for entry, whereas those who immigrate for family reunification are not.…”

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults

“…Available studies do suggest, however, that discordance between the patient's and the clinician's language or limitations in English proficiency challenge health-related communication, reduce diagnostic reliability, decrease the effectiveness of care, and heighten the risks of treatment in psychiatric Kim et al 2011;Leng et al 2010) and nonpsychiatric (Fernandez et al 2011;Wilson et al 2005) settings. Furthermore, in nonpsychiatric settings, the use of professionally trained interpreters during the evaluation of patients with limited English proficiency has been found to reduce communication errors and enhance comprehension of medical information, health care utilization, clinical outcomes, and satisfaction with care (Karliner et al 2007).…”