Journal of General Internal Medicine

, Volume 21, Issue 7, pp 786–791 | Cite as

Linguistic disparities in health care access and health status among older adults

  • Ninez A. Ponce
  • Ron D. Hays
  • William E. Cunningham
Populations At Risk

Abstract

BACKGROUND: English proficiency may be important in explaining disparities in health and health care access among older adults.

SUBJECTS: Population-based representative sample (N=18,659) of adults age 55 and older from the 2001 California Health Interview Survey.

METHODS: We examined whether health care access and health status vary among older adults who have limited English proficiency (LEP), who are proficient in English but also speak another language at home (EP), and who speak English only (EO). Weighted bivariate and multivariate survey logit analyses were conducted to examine the role of language ability on 2 aspects of access to care (not having a usual source of care, delays in getting care) and 2 indicators of health status (self-rated general health and emotional health).

RESULTS: Limited-English proficient adults were significantly worse off (1.68 to 2.49 times higher risk) than EO older adults in 3 of our 4 measures of access to care and health status. Limited-English proficient older adults had significantly worse access to care and health status than EP older adults except delays in care. English proficient adults had 52% increased risk of reporting poorer emotional health compared with EO speakers.

CONCLUSIONS: Provision of language assistance services to patients and training of providers in cultural competence are 2 means by which health care systems could reduce linguistic barriers, improve access to care, and ultimately improve health status for these vulnerable populations.

Key words

health status health care access disparities older adults immigrants 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Woloshin S, Schwartz L, Katz S, Welch H. Is language a barrier to the use of preventive services? J Gen Intern Med. 1997;12:472–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Timmins C. The impact of language barriers on the health care of Latinos in the United States: a review of the literature and guidelines for practice. J Midwifery Womens Health. 2002;47:80–96.PubMedCrossRefGoogle Scholar
  3. 3.
    Flores G, Abreu M, Olivar MA, Kastner B. Access barriers to health care for Latino children. Arch Pediatr Adolesc Med. 1998;152:1119–25.PubMedGoogle Scholar
  4. 4.
    Jacobs EA, Karavolos K, Rathouz PJ, Ferris TG, Powell LH. Limited English proficiency and breast and cervical cancer screening in a multiethnic population. Am J Public Health. 2005;95:1410–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Ngo-Metzger Q, Massagli M, Clarridge B, et al. Linguistic and cultural barriers to care. J Gen Intern Med. 2003;18:44–52.PubMedCrossRefGoogle Scholar
  6. 6.
    Seid MSG, Varni JW. Parents’ perceptions of pediatric primary care quality: effects of race/ethnicity, language, and access. Health Serv Res. 2003;38:1009–31.PubMedCrossRefGoogle Scholar
  7. 7.
    Sarver J, Baker DW. Effect of language barriers on follow-up appointments after an emergency department visit. J Gen Intern Med. 2000;15:256–64.PubMedCrossRefGoogle Scholar
  8. 8.
    Morales L, Cunningham W, Brown J, Liu H, Hays R. Are Latinos less satisfied with communication by health care providers? J Gen Intern Med. 1999;14:409–17.PubMedCrossRefGoogle Scholar
  9. 9.
    Weech-Maldonado R, Morales L, Elliott M, et al. Race/ethnicity, language, and patients’ assessments of care in medicaid managed care. Health Serv Res. 2003;38:789–808.PubMedCrossRefGoogle Scholar
  10. 10.
    Carrasquillo O, Orav EJ, Brennan TA, Burstin HR. Impact of language barriers on patient satisfaction in an emergency department. J Gen Intern Med. 1999;14:82–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Andersen RA. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36:1–10.PubMedCrossRefGoogle Scholar
  12. 12.
    Lara M, Gamboa C, Kahramanian MI, Morales LS, Bautista DE. Acculturation and Latino health in the United States: a review of the literature and its sociopolitical context. Annu Rev Public Health. 2005;26:367–97.PubMedCrossRefGoogle Scholar
  13. 13.
    Berry JW, Kim U, Minde T, Mok D. Comparative studies of acculturative stress. Intern Migr Rev. 1987;21:491–511.CrossRefGoogle Scholar
  14. 14.
    California Health Interview Survey. CHIS 2001 Methodology Series: Report 1—Sample Design. Los Angeles, CA: UCLA Center for Health Policy Research; 2002.Google Scholar
  15. 15.
    California Health Interview Survey. CHIS 2001 Methodology Series: Report 2—Data Collection Methods. Los Angeles, CA: UCLA Center for Health Policy Research; 2002.Google Scholar
  16. 16.
    California Health Interview Survey. CHIS 2001 Methodology Series: Report 4—Response Rates. Los Angeles, CA: UCLA Center for Health Policy Research; 2002.Google Scholar
  17. 17.
    California Health Interview Survey. Revised CHIS 2001 Weights. Los Angeles, CA: UCLA Center for Health Policy Research; 2005.Google Scholar
  18. 18.
    Ponce NA, Lavarreda SA, Yen W, Brown ER, DiSogra C, Satter D. Translation methodology in the California health interview survey: challenges in language translation for a major survey. Public Health Rep. 2004;119:1–18.CrossRefGoogle Scholar
  19. 19.
    Berwick DM, Murphy JM, Goldman PA, Ware JE Jr, Barsky AJ, Weinstein MC. Performance of a five-item mental health-screening test. Med Care. 1991;29:169–76.PubMedCrossRefGoogle Scholar
  20. 20.
    Yamazaki S, Shunchi F, Green J. Usefulness of five-item and three-item mental health inventories screen for depressive symptoms in the general population of Japan. Health Qual Life Outcomes. 2005;3:48.PubMedCrossRefGoogle Scholar
  21. 21.
    Lubetkin EI, Jia H, Gold MR. Med Care. Use of the SF-36 in low-income Chinese American primary care patients. 2003;41:447–57.Google Scholar
  22. 22.
    Bennett JA, Riegel B. United States Spanish short-form-36 health survey: scaling assumptions and reliability in elderly community-dwelling Mexican Americans. Nurs Res. 2003;52:262–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Cornelius LJ. The degree of usual provider continuity for African and Latino Americans. J Health Care Poor Underserved. 1997;8:170–85.PubMedGoogle Scholar
  24. 24.
    Cunningham W, Hays R, Burton T, Kington R. Health status measurement performance and health status differences by age, ethnicity, and gender: assessment in the medical outcomes study. J Health Care Poor Underserved. 2000;11:58–76.PubMedGoogle Scholar
  25. 25.
    David R, Rhee M. The impact of language as a barrier to effective health care in an underserved urban Hispanic community. Mount Sinai J Med. 1998;65:393–7.Google Scholar
  26. 26.
    Jenkins CN, Le T, McPhee SJ, Stewart S, Ha NT. Health care access and preventive care among Vietnamese immigrants: do traditional beliefs and practices pose barriers? Soc Sci Med. 1996;43:1049–56.PubMedCrossRefGoogle Scholar
  27. 27.
    Levkoff S, Cleary P, Wetle T. Differences in the appraisal of health between aged and middle-aged adults. J Gerontol. 1987;42:114–20.PubMedGoogle Scholar
  28. 28.
    Pourat N, Lubben J, Yu H, Wallace S. Perceptions of health and use of ambulatory care: differences between Korean and white elderly. J Aging Health. 2000;12:112–34.PubMedCrossRefGoogle Scholar
  29. 29.
    California Health Interview Survey. CHIS 2001 Methodology Series: Report 3 - Data Processing Procedures. Los Angeles, CA: UCLA Center for Health Policy Research; 2002.Google Scholar
  30. 30.
    Cuellar I, Arnold B, Maldonado RE. The acculturation rating scale for Mexican Americans-II: a revision of the original ARSMA scale. Hispanic J Behav Sci. 1995;17:275–304.CrossRefGoogle Scholar
  31. 31.
    Zhang J, Yu KF. What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA. 1998;280:1690–1.PubMedCrossRefGoogle Scholar
  32. 32.
    Vega WA, Kolody B, Aguilar-Gaxiola S, Alderete E, Catalano R, Caraveo-Anduaga J. Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California. Arch Gen Psychiatry. 1998;55:771–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Takeuchi DT, Chung RC-Y, Lin K-M, et al. Lifetime and twelve-month prevalence rates of major depressive episodes and dysthymia among Chinese Americans in Los Angeles. Am J Psychiatry. 1998;155:1407–14.PubMedGoogle Scholar
  34. 34.
    Yeung ACR, Mischoulon D, Sonawalla S, Wong E, Nierenberg AA, Fava M. Prevalence of major depressive disorder among Chinese-Americans in primary care. Gen Hosp Psychiatry. 2004;26:24–30.PubMedCrossRefGoogle Scholar
  35. 35.
    Gonzalez HM, Haan MN, Hinton L. Acculturation and the prevalence of depression in older Mexican Americans: baseline results of the Sacramento area Latino study on aging. J Am Geriatr Soc. 2001;49:948–53.PubMedCrossRefGoogle Scholar
  36. 36.
    Chen H, Guarnaccia P, Chung H. Self-attention as a mediator of cultural influences on depression. Int J Soc Psychiatry. 2003;3.Google Scholar
  37. 37.
    Uppaluri C, Schumm L, Lauderdale D. Self-reports of stress in Asian immigrants: effects of ethnicity and acculturation. Ethn Dis. 2001;1:107–14.Google Scholar
  38. 38.
    Burr JA, Mutchler JE. English language skills, ethnic concentration, and household composition: older Mexican immigrants. J Gerontol B Psychol Sci Soc Sci. 2003;58:S83–92.PubMedGoogle Scholar
  39. 39.
    US Census Bureau. California—ability to speak English by language spoken at home for the population 5 years and over: 2000. Available at http://www.census.gov/population/cen2000/phc-t37/tab06a.pdf. Accessed August 10, 2005.Google Scholar
  40. 40.
    Rohrer J. Medical care usage and self-rated mental health. BMC Public Health. 2004;4:3.PubMedCrossRefGoogle Scholar
  41. 41.
    Bures R. Childhood residential stability and health at midlife. Am J Public Health. 2003;93:1144–8.PubMedCrossRefGoogle Scholar
  42. 42.
    US Census Bureau. Tm-h015. Percent of occupied housing units without telephone in service: 2000 universe: Occupied housing units. Available at: http://factfinder.census.gov. Accessed August 9, 2005.Google Scholar
  43. 43.
    Schmidley D. The Foreign-Born Population in the United States, March 2002, Current population reports p-20-539, Washington, DC, US Census Bureau, 2003.Google Scholar

Copyright information

© Society of General Internal Medicine 2006

Authors and Affiliations

  • Ninez A. Ponce
    • 4
    • 1
  • Ron D. Hays
    • 4
    • 2
    • 3
  • William E. Cunningham
    • 4
    • 2
  1. 1.UCLA Center for Health Policy ResearchLos AngelesUSA
  2. 2.UCLA School of MedicineLos AngelesUSA
  3. 3.RAND Health ProgramSanta MonicaUSA
  4. 4.UCLA Department of Health ServicesLos Angeles

Personalised recommendations