Journal of General Internal Medicine

, Volume 32, Issue 6, pp 632–639 | Cite as

Disparities in Hypertension Associated with Limited English Proficiency

  • Eun Ji Kim
  • Taekyu Kim
  • Michael K. Paasche-Orlow
  • Adam J. Rose
  • Amresh D. Hanchate
Original Research



Limited English proficiency (LEP) is associated with poor health status and worse outcomes.


To examine disparities in hypertension between National Health and Nutrition Examination Survey (NHANES) respondents with LEP versus adequate English proficiency.


Retrospective analysis of multi-year survey data.


Adults 18 years of age and older who participated in the NHANES survey during the period 2003–2012.

Main Measures

We defined participants with LEP as anyone who completed the NHANES survey in a language other than English or with the support of an interpreter. Using logistic regression, we estimated the odds ratio for undiagnosed or uncontrolled hypertension (systolic blood pressure (SBP) > 140 mmHg or diastolic blood pressure (DBP) > 90 mmHg) among LEP participants relative to those with adequate English proficiency. We adjusted for sociodemographic, acculturation-related, and hypertension-related variables.

Key Results

Fourteen percent (n = 3,269) of the participants had limited English proficiency: 12.4% (n = 2906) used a Spanish questionnaire and 1.6% (n = 363) used an interpreter to complete the survey in another language. Those with LEP had higher odds of elevated blood pressure on physical examination (adjusted odds ratio [AOR] = 1.47 [1.07–2.03]). This finding persisted among participants using an interpreter (AOR = 1.88 [1.15–3.06]) but not among those using the Spanish questionnaire (AOR = 1.32 [0.98–1.80]). In a subgroup analysis, we found that the majority of uncontrolled hypertension was concentrated among individuals with a known diagnosis of hypertension (AOR = 1.80 [1.16–2.81]) rather than those with undiagnosed hypertension (AOR = 1.14 [0.74–1.75]). Interpreter use was associated with increased odds of uncontrolled hypertension, especially among patients who were not being medically managed for hypertension (AOR = 6.56 [1.30–33.12]).


In a nationally representative sample, participants with LEP were more likely to have poorly controlled hypertension than those with adequate English proficiency. LEP is an important driver of disparities in hypertension management and outcomes.


hypertension limited English proficiency NHANES language barrier 



The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, Boston University, or Massachusetts General Hospital.

Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflicts of interest.


Dr. Kim was funded by a training grant from the VA Office of Academic Affiliations and was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through a Boston University Clinical & Translational Science Institute (BU-CTSI) grant (1UL1TR001430).

Prior Presentations

Earlier versions of this work were presented at the Health Literacy Research Conference (Bethesda, MD, November 2015), the regional SGIM (New Haven, CT, March 2016), and the national SGIM (Hollywood, FL, May 2016).

Supplementary material

11606_2017_3999_MOESM1_ESM.docx (15 kb)
ESM 1(DOCX 15 kb)


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Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  • Eun Ji Kim
    • 1
    • 2
  • Taekyu Kim
    • 3
  • Michael K. Paasche-Orlow
    • 2
  • Adam J. Rose
    • 2
  • Amresh D. Hanchate
    • 2
    • 4
  1. 1.Center for Health Organization and Implementation Research (CHOIR)Edith Nourse Rogers Memorial Veterans HospitalBedfordUSA
  2. 2.Section of General Internal MedicineBoston University School of MedicineBostonUSA
  3. 3.Massachusetts General HospitalBostonUSA
  4. 4.VA Boston Healthcare SystemBostonUSA

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