MedWire News: A study in the journal Medical Care reports that Hispanic patients with asthma who have a limited English proficiency have significantly poorer asthma control and lower quality of life (QoL) compared with proficient English speakers.
Juan Wisnivesky (Mount Sinai School of Medicine, New York, USA) and colleagues interviewed 318 adults with asthma who were receiving care at two large inner-city clinics in New York to elucidate the potential relationship of language barriers and asthma outcomes.
The cohort was split into three groups: non-Hispanics who were native English speakers (44%), Hispanics proficient in English (38%) and Hispanics with limited English proficiency (18%). Over 80% of all Hispanics in this study were from Puerto Rico and those with limited English proficiency were significantly older, more likely to be insured by Medicare and had lower household incomes. These factors were taken into account in the multivariate analysis of the results.
Wisnivesky et al report that patients with limited English proficiency had significantly worse asthma control, as indicated by higher scores on the Asthma Control Questionnaire, than non-Hispanics and Hispanics proficient in English (3.6 vs 2.6 and 2.9, respectively). This result remained significant in the multivariate analysis.
Hispanics with limited English proficiency were 2.4 times more likely to have an exacerbation requiring outpatient treatment than non-Hispanic patients. They also had a significantly greater number of emergency department visits or hospitalizations than non-Hispanics (odds ratio [OR]=4.36). However, there was no significant difference in resource utilization between non-Hispanics and Hispanics proficient in English.
The scores from the Asthma Quality of Life Questionnaires (AQoLQ) showed a similar pattern, with Hispanics with limited English showing a poorer quality of life than non-Hispanics (AQoLQ score 3.8 vs 4.8). Again there was no significant difference in the scores from non-Hispanics and Hispanics proficient in English (4.8 vs 4.3).
The authors also note differing opinions on medication and beliefs about asthma between the groups. Hispanics with limited English were more likely to worry about potential side effects of treatment, had lower self-efficacy for asthma control and use of their inhaled corticosteroids (ICS) as indicated by their doctor, and were also more likely to believe that asthma is not a lifelong disease, than the other two groups.
“It is possible that the observed lower rates of adherence with ICS among Hispanics with limited proficiency may be related to some of these factors” say the researchers.
They conclude: “Although further studies are needed to better understand the potential mechanisms underlying the observed association between language proficiency on asthma morbidity, these results suggest that Hispanic asthmatics with limited proficiency are a group at high risk for poor outcomes.”
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