Specialty Care Utilization Among Adults with Limited English Proficiency

Jessica Himmelstein; Christopher Cai; David U Himmelstein; Steffie Woolhandler; David H Bor; Samuel L Dickman; Danny McCormick

doi:10.1007/s11606-022-07477-6

Specialty Care Utilization Among Adults with Limited English Proficiency

J Gen Intern Med. 2022 Dec;37(16):4130-4136. doi: 10.1007/s11606-022-07477-6. Epub 2022 Mar 29.

Authors

Jessica Himmelstein^{1

2}, Christopher Cai^{3

4}, David U Himmelstein^{5

4

6}, Steffie Woolhandler^{5

4

6}, David H Bor^{5

4}, Samuel L Dickman^{7

8}, Danny McCormick^{5

4}

Affiliations

¹ Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA. jhimmelstein@challiance.org.
² Harvard Medical School, Boston, MA, USA. jhimmelstein@challiance.org.
³ Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
⁴ Harvard Medical School, Boston, MA, USA.
⁵ Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA.
⁶ City University of New York at Hunter College, New York, NY, USA.
⁷ Planned Parenthood South Texas, San Antonio, TX, USA.
⁸ The University of Texas at Austin, Austin, TX, USA.

Abstract

Background: People with limited English proficiency (LEP) face greater barriers to accessing medical care than those who are English proficient (EP). Language-related differences in the use of outpatient care across the full spectrum of physician specialties have not been studied.

Objective: To compare outpatient visit rates to physicians in 28 specialties by people with LEP vs EP.

Design: Multivariable negative binomial regression analysis of nationally representative data from the Medical Expenditure Panel Survey (pooled 2013-2018) with adjustment for age, sex, and self-reported health status.

Participants: 149,611 survey respondents aged 18 and older.

Exposure: LEP, defined as taking the survey in a language other than English.

Main measures: Annual per capita adjusted visit rate ratios (ARRs) comparing visit rates by LEP and EP persons to individual specialties, and to three categories of specialties: (1) primary care (internal or family medicine, geriatrics, general practice, or obstetrics/gynecology), (2) medical-subspecialties, or (3) surgical specialties.

Key results: Patients with LEP were underrepresented in 26 of 28 specialties. Disparities were particularly large for the following: pulmonology (ARR, 0.26; 95% CI, 0.20-0.35), orthopedics (ARR, 0.35; 95% CI, 0.30-0.40), otolaryngology (ARR, 0.40; 95% CI, 0.27-0.59), and psychiatry (ARR, 0.43; 95% CI, 0.32-0.58). Among individuals with several specific common chronic conditions, LEP-EP disparities in visits to specialties in those conditions generally persisted. Disparities were larger for medical subspecialties (ARR, 0.41; 95% CI, 0.36-0.46) and surgical specialties (ARR, 0.46; 95% CI, 0.42-0.50) than for primary care (ARR, 0.76; 95% CI, 0.72 to 0.79).

Conclusions: Patients with LEP are underrepresented in most outpatient specialty practices, particularly medical subspecialties and surgical specialties. Our findings highlight the need to remove language barriers to physician services in order to ensure access to the full spectrum of outpatient specialty care for people with LEP.

Keywords: access; disparities; language barriers; limited English proficiency; specialty care.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adult
Ambulatory Care
Communication Barriers
Health Status
Humans
Language
Limited English Proficiency*
Patient Acceptance of Health Care* / statistics & numerical data
Specialization