Disparities in Health Care by Race, Ethnicity, and Language Among the Insured

Fiscella, Kevin; Franks, Peter; Doescher, Mark P.; Saver, Barry G.

doi:10.1097/00005650-200201000-00007

Cited by 776 publications

(478 citation statements)

References 31 publications

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“…This is consistent with other reports. 3,10,23 However, in our adjusted model, we found that the Other Language-Discordant cohort is as likely as the EnglishConcordant cohort to be adherent to CRC screening guidelines, while the Other Language-Concordant cohort is less likely to be adherent. This was unexpected.…”

Section: Discussionmentioning

confidence: 56%

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Patient-Provider Language Concordance and Colorectal Cancer Screening

et al. 2010

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BACKGROUND AND OBJECTIVE: Patient-provider language barriers may play a role in health-care disparities, including obtaining colorectal cancer (CRC) screening. Professional interpreters and language-concordant providers may mitigate these disparities. DESIGN, SUBJECTS, AND MAIN MEASURES:We performed a retrospective cohort study of individuals age 50 years and older who were categorized as EnglishConcordant (spoke English at home, n=21,594); Other Language-Concordant (did not speak English at home but someone at their provider's office spoke their language, n=1,463); or Other Language-Discordant (did not speak English at home and no one at their provider's spoke their language, n=240). Multivariate logistic regression assessed the association of language concordance with colorectal cancer screening. KEY RESULTS: Compared to English speakers, nonEnglish speakers had lower use of colorectal cancer screening (30.7% vs 50.8%; OR, 0.63; 95% CI, 0.51-0.76). Compared to the English-Concordant group, the Language-Discordant group had similar screening (adjusted OR, 0.84; 95% CI, 0.58-1.21), while the Language-Concordant group had lower screening (adjusted OR, 0.57; 95% CI, 0.46-0.71). CONCLUSIONS: Rates of CRC screening are lower in individuals who do not speak English at home compared to those who do. However, the Language-Discordant cohort had similar rates to those with English concordance, while the Language-Concordant cohort had lower rates of CRC screening. This may be due to unmeasured differences among the cohorts in patient, provider, and health care system characteristics. These results suggest that providers should especially promote the importance of CRC screening to non-English speaking patients, but that language barriers do not fully account for CRC screening rate disparities in these populations.

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Section: Discussionmentioning

confidence: 56%

“…2 Language plays a role in these health-care disparities. 3,4 Language barriers may undermine medical communication, lead to inaccurate diagnosis, and contribute to poorer management or treatment adherence. 5 Of individuals who do not speak English at home, roughly 44% speak English "less than well."…”

Section: Introductionmentioning

confidence: 99%

Patient-Provider Language Concordance and Colorectal Cancer Screening

et al. 2010

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“…Language barriers play a significant role in poor health processes and outcomes, [4][5][6][7] including reduced accessing of preventive services 8,9 and cancer screening rates among LEP patients. [10][11][12][13] These obstacles to cancer screenings for LEP patients can be reduced with language assistance. Patient navigation is a promising intervention to eliminate language as a barrier to cancer screening for LEP patients.…”

Section: Introductionmentioning

confidence: 99%

Navigating Language Barriers: A Systematic Review of Patient Navigators’ Impact on Cancer Screening for Limited English Proficient Patients

et al. 2016

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OBJECTIVES:To systematically review the literature on the impact of patient navigators on cancer screening for limited English proficient (LEP) patients. DATA SOURCES: Electronic databases (PubMed, PsycINFO via OVID, Web of Science, Cochrane, EMBASE, and Scopus) through 8 May 2015. ELIGIBILITY CRITERIA: Articles in this review had: (1) a study population of LEP patients eligible for breast, cervical or colorectal cancer screenings, (2) a patient navigator intervention to provide services prior to or during cancer screening, (3) a comparison of the patient navigator intervention to either a control group or another intervention, and (4) language-specific outcomes related to the patient navigator intervention. STUDY APPRAISAL:We assessed the quality of the articles using the Downs and Black Scale. RESULTS: Fifteen studies met the inclusion criteria and evaluated the screening rates for breast, colorectal, and cervical cancer in 15 language populations. Fourteen studies resulted in improved screening rates for LEP patients between 7 and 60 %. There was great variability in the patient navigation interventions evaluated. Training received by navigators was not reported in nine of the studies and no studies assessed the language skills of the patient navigators in English or the target language. LIMITATIONS: This study is limited by the variability in study designs and limited reporting on patient navigator interventions, which reduces the ability to draw conclusions on the full effect of patient navigators. CONCLUSIONS: Overall, we found evidence that navigators improved screening rates for breast, cervical and colorectal cancer screening for LEP patients. Future studies should systematically collect data on the training curricula for navigators and assess their English and nonEnglish language skills in order to identify ways to reduce disparities for LEP patients.

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“…First, language barriers are reported as a limiting factor in access to healthcare for foreigners. [14][15][16][17][18][19] Interpreters are unfortunately not always available, even in university primary care settings collaborating with an interpreter service.…”

Section: Discussionmentioning

confidence: 99%