The Impact of Limited English Proficiency on Healthcare Access and Outcomes in the U.S.: A Scoping Review

Twersky, Sylvia E.; Jefferson, Rebeca; Garcia-Ortiz, Lisbet; Williams, Erin; Pina, Carol

doi:10.3390/healthcare12030364

Healthcare

2024

DOI: 10.3390/healthcare12030364

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The Impact of Limited English Proficiency on Healthcare Access and Outcomes in the U.S.: A Scoping Review

Sylvia E. Twersky,

Rebeca Jefferson,

Lisbet Garcia-Ortiz

et al.

Abstract: A majority of individuals with limited English proficiency (LEP) in the U.S. are foreign-born, creating a complex intersection of language, socio-economic, and policy barriers to healthcare access and achieving good outcomes. Mapping the research literature is key to addressing how LEP intersects with healthcare. This scoping review followed PRISMA-ScR guidelines and included PubMed/MEDLINE, CINAHL, Sociological Abstracts, EconLit, and Academic Search Premier. Study selection included quantitative studies sinc… Show more

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Cited by 15 publications

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Associations between language, telehealth, and clinical outcomes in patients with cancer during the COVID‐19 pandemic

Azizi,

Mahadevan,

Arora

et al. 2024

Cancer Medicine

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BackgroundThe COVID‐19 pandemic prompted a surge in telehealth utilization. However, language barriers have emerged as a potential obstacle to effective telemedicine engagement, impacting millions of limited English proficient (LEP) individuals. Understanding the role of language spoken in telehealth outcomes is critical, particularly in cancer care, in which consistent follow‐up and communication are vital. The primary objective was to assess the impact of telehealth utilization and primary language spoken on clinical outcomes in cancer patients.MethodsThis study utilized a retrospective cohort design, encompassing cancer patients seen at the Chao Family Comprehensive Cancer Center between March 1, 2020, and December 31, 2022. The study incorporated both in‐person and telehealth visits, examining the association between encounter type and clinical outcomes.ResultsThe study included 7890 patients with more than one outpatient visit during the study period. There was decreased telehealth utilization in non‐English speaking cancer patients throughout the pandemic. Increased telehealth utilization was associated with higher rates of admission, irrespective of cancer type. Additionally, telehealth visits were associated with longer duration of subsequent admissions compared to in‐person visits. Spanish‐speaking patients utilizing telehealth had higher rates of re‐admission compared to English speakers utilizing telehealth. Patients who died had higher rates of telehealth utilization compared to patients who survived.Conclusions and RelevanceThis study demonstrates that primary language spoken is associated with differences in telehealth utilization and associated outcomes in cancer patients. These differences suggest that the interplay of telehealth and language could contribute to widening of disparities in clinical outcomes in these populations. The study underscores the need to optimize telehealth usage and minimize its limitations to enhance the quality of cancer care in a telehealth‐driven era.

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Associations between language, telehealth, and clinical outcomes in patients with cancer during the COVID‐19 pandemic

Azizi,

Mahadevan,

Arora

et al. 2024

Cancer Medicine

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Disparities in Adult Otolaryngology Patients with Limited English Proficiency: A Systematic Review

Ferraro,

Villarin,

Jung

et al. 2024

The Laryngoscope

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ObjectiveLimited English proficiency (LEP) has become increasingly recognized as an independent predictor of adverse health outcomes in the United States. We aim to examine trends and summarize current insights into LEP‐related disparities in adult otolaryngology.Data SourcesWeb of Science, PubMed, and Scopus.MethodsA systematic review of US‐based, peer‐reviewed literature evaluating outcomes in adult otolaryngology across primary language or varying levels of English proficiency; results were analyzed for study design, subspecialty, cohort demographics, and outcomes; findings were further assessed with the Kilbourne conceptual framework for health care disparities.ResultsAn initial search yielded 3886 articles. After removal of duplicates, 2906 articles were screened and 31 studies were included after full‐text analysis. Head and Neck Oncology (25.8%) and Otology (16.1%) were the most highly represented subspecialty topics. Patients with LEP represented an average of 21.71% (Range 2.21% – 51%) of the study populations. Definitions of LEP were variable. Furthermore, studies specifying patient‐reported LEP status reported significant findings more often than those using electronic health record‐derived data (p < 0.01). Under the Kilbourne framework, all studies were “detecting” (N = 21, 67.7%) and “understanding” (N = 10, 32.3%) disparities. In outcomes‐focused studies, patients with LEP presented with a higher burden of oncologic disease, more severe hearing loss, and disparities in treatment access/implementation.ConclusionPatients with LEP are adversely impacted across various otolaryngology subspecialties. Defining these inequities is vital to provide more targeted and comprehensive care for patients with LEP.Level of EvidenceNA Laryngoscope, 2024

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Nasopharynx Cancer in the United States: Racial and Ethnic Disparities in Stage at Presentation

Dee,

Wang,

et al. 2024

The Laryngoscope

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IntroductionAlthough nasopharynx cancer (NPC) is rare in the United States, global epidemiology varies greatly. Therefore, understanding NPC disparities in the diverse US setting is critical.Methods and MaterialsData from the National Cancer Database (NCDB, 2004‐2021) identified patients with NPC; NCDB allows disaggregation by Asian American (AA) subgroups. Multivariable ordinal logistic regression adjusting for demographic and socioeconomic factors defined adjusted odds ratios (aORs).ResultsOf 15,862 patients, 11,173 (70.4%) were male (median age 59). Commonest groups included 10,034 (63.3%) White, 2,272 (14.3%) Black, 1,103 (7.0%) Chinese, 442 (2.8%) Filipino, and 338 (2.1%) Vietnamese patients. Prior to disaggregation, the proportion of stage IV disease at presentation was 43.2% among White (ref), 50.0% among Black (aOR 1.12, p = 0.012), 52.0% among Native American (aOR 1.18, p > 0.05), 41.9% among AA (aOR 0.97, p > 0.05), and 55.1% among Native Hawaiian and Other Pacific Islander patients (aOR 1.47, p = 0.021).Upon disaggregation, the proportion of stage IV disease was the greatest (>50%) among Black (50.0%, aOR 1.12, p = 0.012), Laotian (61.5%, aOR 2.21, p = 0.001), Hmong (73.2%, aOR 2.92, p < 0.001), and Other Pacific Islander patients (60.9%, aOR 1.83, p = 0.004); 44.2% of Filipino patients also presented with stage IV disease (aOR 1.21, p = 0.033). Odds of presenting with advanced stage disease were lower among Chinese patients (35.7% stage IV, aOR 0.72, p < 0.001).ConclusionsAlthough most NPC patients were Chinese, White, or Black, stage IV disease at presentation was most common among Hmong, Laotian, non‐Hawaiian Pacific Islander, and Black patients. Efforts are needed to improve awareness of NPC among less canonically affected groups.Level of EvidenceLevel 4 Laryngoscope, 2024

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The Impact of Limited English Proficiency on Healthcare Access and Outcomes in the U.S.: A Scoping Review

Cited by 15 publications

References 143 publications

Associations between language, telehealth, and clinical outcomes in patients with cancer during the COVID‐19 pandemic

Associations between language, telehealth, and clinical outcomes in patients with cancer during the COVID‐19 pandemic

Disparities in Adult Otolaryngology Patients with Limited English Proficiency: A Systematic Review

Nasopharynx Cancer in the United States: Racial and Ethnic Disparities in Stage at Presentation

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