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      Primary Language and Receipt of Recommended Health Care Among Hispanics in the United States

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      , MD, MS , 1 , 2 , 6 , , MD, MS 3 , , MD, MPH 4 , 5

      Journal of General Internal Medicine

      Springer-Verlag

      disparities, Hispanic health, language barriers

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          Abstract

          Background

          Disparities in health care services between Hispanics and whites in the United States are well documented.

          Objective

          The objective of the study was to determine whether language spoken at home identifies Hispanics at risk for not receiving recommended health care services.

          Design

          The design of the study was cross-sectional, nationally representative survey of households.

          Patients

          The patients were non-Hispanic white and Hispanic adults participating in the 2003 Medical Expenditure Panel Survey.

          Measurements

          We compared receipt of ten recommended health care services by ethnicity and primary language adjusting for demographic and socioeconomic characteristics, health status, and access to care.

          Results

          The sample included 12,706 whites and 5,500 Hispanics. In bivariate comparisons, 57.0% of whites received all eligible health care services compared to 53.6% for Hispanics who spoke English at home, 44.9% for Hispanics who did not speak English at home but who were comfortable speaking English, and 35.0% for Hispanics who did not speak English at home and were uncomfortable speaking English ( p < .001). In multivariate logistic models, compared to non-Hispanic whites, Hispanics who did not speak English at home were less likely to receive all eligible health care services, whether they were comfortable speaking English (risk ratio [RR] 0.88, 95% confidence interval [CI] 0.74–0.97) or not (RR 0.84, 95% CI 0.68–0.95).

          Conclusions

          Speaking a language other than English at home identified Hispanics at risk for not receiving recommended health care services, whether they were comfortable in speaking English or not. Identifying the mechanism for disparities by language usage may lead to interventions to reduce ethnic disparities.

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          Most cited references 21

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          Regression models for categorical and limited dependent variables

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            All-or-none measurement raises the bar on performance.

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              Are Latinos less satisfied with communication by health care providers?

              To examine associations of patient ratings of communication by health care providers with patient language (English vs Spanish) and ethnicity (Latino vs white). A random sample of patients receiving medical care from a physician group association concentrated on the West Coast was studied. A total of 7,093 English and Spanish language questionnaires were returned for an overall response rate of 59%. Five questions asking patients to rate communication by their health care providers were examined in this study. All five questions were administered with a 7-point response scale. We estimated the associations of satisfaction ratings with language (English vs Spanish) and ethnicity (white vs Latino) using ordinal logistic models, controlling for age and gender. Latinos responding in Spanish (Latino/Spanish) were significantly more dissatisfied compared with Latinos responding in English (Latino/English) and non-Latino whites responding in English (white) when asked about: (1) the medical staff listened to what they say (29% vs 17% vs 13% rated this "very poor," "poor," or "fair"; p <.01); (2) answers to their questions (27% vs 16% vs 12%; p <.01); (3) explanations about prescribed medications (22% vs 19% vs 14%; p <.01); (4) explanations about medical procedures and test results (36% vs 21% vs 17%; p <.01); and (5) reassurance and support from their doctors and the office staff (37% vs 23% vs 18%; p <.01). This study documents that Latino/Spanish respondents are significantly more dissatisfied with provider communication than Latino/English and white respondents. These results suggest Spanish-speaking Latinos may be at increased risk of lower quality of care and poor health outcomes. Efforts to improve the quality of communication with Spanish-speaking Latino patients in outpatient health care settings are needed.
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                Author and article information

                Contributors
                +1-310-4783711 , +1-310-2683044 , eric.cheng@va.gov
                Journal
                J Gen Intern Med
                Journal of General Internal Medicine
                Springer-Verlag (New York )
                0884-8734
                1525-1497
                24 October 2007
                November 2007
                : 22
                : Suppl 2
                : 283-288
                Affiliations
                [1 ]Department of Neurology, VA Greater Los Angeles, Los Angeles, CA USA
                [2 ]Department of Neurology, School of Medicine, University of California Los Angeles, Los Angeles, CA USA
                [3 ]Department of Pediatrics, University of Southern California, Los Angeles, CA USA
                [4 ]Department of Medicine, School of Medicine, University of California Los Angeles, Los Angeles, CA USA
                [5 ]Department of Health Services, School of Public Health, University of California Los Angeles, Los Angeles, CA USA
                [6 ]VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., B500, ML 127, Los Angeles, CA 90073 USA
                Article
                346
                10.1007/s11606-007-0346-6
                2078546
                17957412
                © Society of General Internal Medicine 2007
                Categories
                Original Article
                Custom metadata
                © Society of General Internal Medicine 2007

                Internal medicine

                hispanic health, disparities, language barriers

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