Health status among US Hispanics: ethnic variation, nativity, and language moderation

BACKGROUND: The relationship between health status and Hispanic ethnicities, language, and nativity is poorly understood, due to the limitations and conflicting findings of previous studies. OBJECTIVES: To examine the effects of language and nativity on health status in Hispanic ethnic subgroups and non-Hispanic whites (whites). RESEARCH DESIGN: Cross-sectional analyses of data from the 1998-2004 National Health Interview Survey linked to the 1999-2005 Medical Expenditure Panel Survey. Health status was regressed on race/ethnicity, interview language, and nativity, with adjustment for demographic and socioeconomic variables. SUBJECTS: A total of 16,489 Hispanics (13,522 Mexicans, 778 Cubans, 1360 Puerto Ricans, and 829 Dominicans) and 45,422 whites. MEASURES: SF-12 mental (MCS-12) and physical (PCS-12) component summary scores. RESULTS: In adjusted analyses, Mexicans had significantly higher MCS-12 scores than other Hispanics and whites, with the largest advantage noted for Spanish-speaking Mexicans. Ethnic origin * nativity interaction effects were significant for both MCS-12 [adjusted Wald test, F (3236) = 7.27, P = 0.0001] and PCS-12 [F (3236) = 4.75, P = 0.0031]. Continental US-born Mexicans had worse mental and physical health status than non-US-born Mexicans. By contrast, continental US birth was associated with better mental health status for Cubans and Dominicans, and better physical health status for Puerto Ricans. CONCLUSIONS: Complex interactions exist among language, nativity, ethnicity, and health status among Hispanics. Mexicans have better health status than whites and other Hispanics, and the moderating effects of nativity and language differ for Mexicans compared with other Hispanics. Future research should approach Hispanics as a diverse grouping rather than a monolithic entity.     

Racial/ethnic differences in FIM scores and length of stay for underinsured patients undergoing stroke inpatient rehabilitation

OBJECTIVE: To explore racial/ethnic differences in FIM data from admission to discharge in underinsured patients undergoing inpatient stroke rehabilitation. DESIGN: This is a retrospective analysis of the Uniform Data System for Medical Rehabilitation (UDSMR) database of an inpatient rehabilitation unit of a county hospital in a large urban city. Data included 171 adult patients admitted to the stroke rehabilitation unit between January 2000 and October 2003. Main outcome measures included admission and discharge total FIM score, FIM gain, FIM efficiency, and length of stay (LOS). Data were analyzed using chi analyses, t tests, univariate analysis of variance, binary logistic regression, and hierarchical multiple regression. RESULTS: Data from 68 Hispanic, 83 black, and 20 white patients were included in the study. Univariate tests revealed that race/ethnicity groups differed significantly on admission FIM score (F=5.38, P<0.005), FIM gain (F=4.35, P<0.014), and FIM efficiency (F=3.42, P<0.035). Post hoc pairwise comparisons revealed that Hispanics had lower admission FIM scores than blacks (58.9 vs. 68.9). However, Hispanics had higher FIM gain scores than blacks (26.8 vs. 21.5). Race/ethnicity was not significantly related to age, gender, side of stroke, type of stroke, time from onset of stroke to rehabilitation admission, discharge FIM score, or LOS. Multiple regression analyses revealed that after controlling for all other available factors, race/ethnicity accounted for a significant amount of additional variance in admission FIM score (5.8%) and FIM efficiency (4.6%), but not in discharge FIM score, FIM gain, or LOS. Race/ethnicity was not predictive of discharge disposition. CONCLUSIONS: Differences in functional independence at admission to poststroke rehabilitation and the average daily improvement in function are related, in part, to patients' race/ethnicity. Differences in change in functional independence from admission to discharge (FIM gain) are not related to race/ethnicity once other factors, particularly admission FIM score, are taken into account. Future studies should identify reasons why Hispanics have lower admission FIM scores because demographic and stroke-related variables were not related to ethnicity yet have outcomes similar to blacks and whites at discharge.     

Receiving advice about child mental health from a primary care provider: African American and Hispanic parent attitudes

BACKGROUND: Primary care providers (PCPs) play a critical role in the identification and treatment of child and adolescent mental health problems but few studies have examined parents' attitudes on receiving advice about child mental health from a PCP and whether attitudes are associated with race or ethnicity. OBJECTIVE: To determine if race and ethnicity were associated with parents' attitudes on receiving advice about child mental health from a PCP. SUBJECTS: Data were collected during 773 visits to 54 PCPs in 13 diverse clinics. Families were 56.5% white, 33.3% African American, and 10.1% Hispanic. MEASURES: The parent reported attitudes associated with receiving advice about child mental health from the PCP. The parent completed the Strengths and Difficulties Questionnaire to report youth mental health. PCPs completed measures of psychosocial orientation, confidence in mental health treatment skills, and the accessibility of mental health specialists. RESULTS: Hispanics were more likely than Non-Hispanics to agree that PCPs should treat child mental health and were more willing to allow their child to receive medications or visit a therapist for a mental health problem if recommended by the PCP. African Americans were significantly less willing than whites and Hispanics to allow their child to receive medication for mental health but did not differ in their willingness to visit a therapist. CONCLUSIONS: Race and ethnicity were associated with parents' attitudes on receiving advice about child mental health from a PCP. Primary care may be a good point of intervention for Hispanic youth with mental health needs.     

Improving identification of Hispanic males in Medicare: use of surname matching

OBJECTIVES: Medicare administrative and claims files maintained by the Centers for Medicare and Medicaid Services (CMS) are frequently used to examine racial and ethnic disparities in healthcare use. However, identification of Hispanic ethnicity for beneficiaries in the Medicare claims files is problematic, greatly limiting the use of these administrative data for examining race/ethnicity differences. This article reports on 2 studies assessing the effectiveness of a Hispanic surname match for improving the accuracy of race/ethnicity codes for elderly males in the Medicare data sets. METHODS: Study 1 used survey data to compare a Medicare race code + Spanish surname composite indicator to self-identification as Hispanic. Study 2 used Medicare administrative files and U.S. Census 2000 data to identify how well the Medicare race code alone and the Medicare race code + Spanish surname composite indicator compared with estimates obtained from census data for 16 U.S. counties dispersed across 5 states. RESULTS: Using self-identification as the gold standard, including the Spanish surname match increased accuracy for Hispanics and whites compared with the Medicare race code alone. The Spanish surname match also dramatically improved the Medicare code's estimation of elderly Hispanic and white males compared with county-level census data. CONCLUSIONS: Augmenting the Medicare race code with a match to Spanish surnames yields substantial improvement in the identification of elderly Hispanic and white non-Hispanic male Medicare beneficiaries. Using surname information to supplement the Medicare race code could greatly enhance researchers' ability to examine healthcare equity.     

Conducting surveys with multidisciplinary health care providers: Current challenges and creative approaches to sampling,recruitment, and data collection

Surveys represent one of the most common and useful ways to collect self‐reported data on a wide variety of topics and from a diversity of respondents, including health care providers (HCPs). Unfortunately, survey response rates have been declining for decades; surveys with HCPs often yield response rates of 40% or less. Another major challenge in surveys with HCPs arises from difficulties in identifying appropriate sampling frames. The lack of appropriate sampling frames is particularly problematic when trying to survey multiple types of HCPs or those who work in unusual practice settings or specialties. The purpose of this paper is to describe the current challenges to survey research with college HCPs who are members of multidisciplinary care teams, and propose alternative approaches to sampling and data collection. An exemplar is provided in which three different approaches to sampling, recruitment and data collection were undertaken with a multidisciplinary sample of college HCPs. The three approaches are compared in terms of response rates, costs, and sample characteristics. Differences were noted in effort, response rates, and sample characteristics. Respondents recruited from professional organization mailing lists were disproportionately from smaller, private college/universities, as compared with those recruited from colleges/universities selected from a U.S. Department of Education list. However, no differences in variables of interest were found between the three samples, reducing concerns of potential bias. Developing best practices for surveying multiple types of HCPs will become increasingly important as we seek to better understand current care processes and plan implementation studies to promote the adoption of practice recommendations.     

PS2-01: DISparities and Culture: Outcomes in Vitality Research (DISCOVeR) Program

Background/Aims National health priorities include reduction of health disparities among racial/ethnic minorities. The cultural and linguistic diversity in the Palo Alto Medical Foundation (PAMF) service areas presented a compelling case for improving the collection of race, ethnicity, ancestry and primary language (R/E/A/L) data to accurately assess and address health disparities across all racial/ethnic groups. Methods In May 2008, the PAMF began collecting patient self-reported R/E/A/L information, following the format of the U.S. 2000 and 2010 Census. The paper questionnaire (available in 9 languages) collected information on race (including Asian subcategories), Hispanic Origin (including Hispanic subcategories), ancestry (free text), preferred spoken language (free text), and interpreter services (Y or N). This information was subsequently entered in the patient's electronic health record by clinic staff. Results Across PAMF, there are over 650,000 active patients with approximately 2.3 million patient visits per year. To date, of the active PAMF patients who have self-reported R/E/A/L information (65% of all active patients), 54% self-identify as Non-Hispanic White/Caucasian, 30% self-identify as one of the 6 major Asian racial/ethnic groups (12% Asian Indian, 11% Chinese, 3% Filipino, 1% each of Japanese, Korean and Vietnamese), 2% self-identify as Black/African American and approximately 10% self-identify as Hispanic/Latino. Most patients are willing to provide the requested information (> 90%). The accuracy of transfer of data from the paper questionnaire to the EHR across questions was high (92-97%). Discussion Patient R/E/A/L data has been used to identify racial/ethnic differences in cardiovascular disease and type 2 diabetes prevalence rates. These research findings have allowed PAMF to implement several culturally competent clinical programs, with the goal of improving healthcare for diverse populations. Our experience demonstrates the feasibility and benefits of collecting R/E/A/L data in an ambulatory health care setting to assess and address health disparities.     

Survey of EMTs' attitudes towards death

INTRODUCTION: The purpose of this study was to ascertain information about emergency medical technicians' (EMTs') attitudes towards their training, comfort, and roles when a patient dies on-scene. METHODS: A sample of 136 EMTs (all levels) from 14 different states participated in a survey prior to completing a continuing education program. About 40% (n = 54) of the EMTs were attending a training program related to death based on the Emergency Death Education and Crisis Training Curriculum, while 60% (n = 82) were attending an EMT training program not related to death. Each participant answered questions about their attitudes towards a death on-scene using a five-point Likert scale. The EMTs were compared by level-of training (EMT-B/EMT-I and EMT-P), and by type of educational program attended (death-related education and non-death-related education). RESULTS: Most (82%) participants reported that an EMT's actions impact the grief process of a bereaved family. About half (54%) reported that an EMT's role should include notifying the family of the death. However, three-quarters (76%) reported that they had not been trained adequately to make a death notification or help the family with their grief. Many (40%) felt uncomfortable making a death notification. Differences were present in EMTs enrolled in the death education courses as compared to those attending an educational program not related to death. Differences also were found in the levels of EMTs (EMT-B/EMT-I versus EMT-Paramedics). CONCLUSION: This study provides new insights about EMTs' attitudes towards death and the death-related training they receive.     

Patient attitudes to nursing students in urology outpatients

Urological conditions are increasingly being managed in an outpatient setting and this environment can offer valuable training in urology nursing particularly with the emergence of nurse‐led clinics. Patient attitudes to nursing students may influence the effectiveness of these training opportunities. We set out to determine patient attitudes to nursing students in urology outpatients and whether opinions are related to patient age, ethnicity or prior exposure to students. Questionnaires were given to all patients attending urology outpatient clinics until 500 completed questionnaires were collected. The questionnaire consisted of nine questions concerning patient demographics and attitudes towards the presence of nursing students. Patients were also asked to grade their comfort with a student’s presence from 0, indicating very comfortable, to 10, indicating very uncomfortable. Only 12% of patients had some degree of objection to the presence of student nurses and most patients (72%) had no preference as to the student gender. When means were derived for patients’ acceptance of the presence of student nurses, there was a significantly lower mean score, indicating more acceptance in patients aged over 30 years compared with those aged under 30 years (p ≤ 0·0001). This also applied to those who spoke English as their first language compared with those who did not (p = 0·063), and to those who had previously been exposed to nursing students compared with those with no exposure (p = 0·0002). Overall, patients were comfortable with nursing students attending their urological outpatient assessment. The patient groups that objected the most were those under the age of 30 years, those who did not speak English as their first language and those with no prior exposure to students.     

Race and ethnicity as variables in Nursing Research, 1952-2000

BACKGROUND: Although the use of race and ethnicity as variables in research has increased over the past five decades, there is confusion regarding the meaning of the terms, as well as how the words are defined and determined in scientific inquiry. OBJECTIVE: To review the use of race and ethnicity as variables in nursing research literature. METHODS: Original research articles published in Nursing Research in the years, 1952, 1955, and every 5 years thereafter through 2000 were reviewed. Those articles describing human characteristics (N = 337) were analyzed for content concerning: (a) frequency of racial and ethnic terms, (b) words used for racial and ethnic categories, (c) detinitions of racial and ethnic terms, and (d) how a study participant's race or ethnicity was determined. RESULTS: Racial and ethnic variables were mentioned in 167 of the 337 reviewed articles. Eighty-one terms and word phrases were used for these variables. In only five articles were the variables defined. Race and ethnic labels were often intermixed and the majority of studies provided no information about how categorization of the participant's race or ethnicity was made. In addition, there was relatively little growth in the number of studies that had racial/ethnic groups, other than Whites, as the majority of the sample. CONCLUSION: Racial and ethnic variables provide nurse researchers with many challenges. Although race and ethnicity were widely used in Nursing Research articles, the categories were not defined in the majority of papers, and methods used to determine a participant's race or ethnicity were unclear. In order to construct a common and consistent understanding of racial and ethnic categories, nurse researchers should be explicit regarding the rationale related to their use of the categories and the assumptions underlying particular racial and ethnic categorizations.     

Racial and ethnic differences in a patient survey: patients' values, ratings, and reports regarding physician primary care performance in a large health maintenance organization

BACKGROUND: Few studies have investigated the influence of race and/or ethnicity on patients' ratings of quality of care. None have incorporated patients' values and beliefs regarding medical care in assessing these possible differences. OBJECTIVES: We explored whether patients' values, ratings, and reports regarding physicians' primary care performance differed by race and/or ethnicity. RESEARCH DESIGN: This was a cross-sectional, mailed patient survey. SUBJECTS: The study subjects were adult primary care patients in a large health maintenance population (7,747 whites, 836 blacks, 710 Latinos, and 1,007 Asians). MEASURES AND METHODS: Ratings of the following dimensions of primary care were measured: technical competence, communication, accessibility, prevention and health promotion, and overall satisfaction. Patients' values regarding these dimensions and their confidence in medical care were measured. Multivariate analyses yielded associations of race/ethnicity with satisfaction and with reports of prevention services received. RESULTS: For 7 of the 10 dimensions of primary care measured, Asians rated physician performance significantly less favorably than did whites, including differences among Asian ethnic subgroups. Latinos rated physicians' accessibility less favorably than did whites. Blacks rated physicians' psychosocial and lifestyle health promotion practices higher than did whites. No differences were found in patient reports of prevention services received, except Pacific Islanders reported receiving significantly more prevention services than whites. CONCLUSIONS: In a large HMO population, significant differences were found by race and ethnicity, and among Asian ethnic subgroups, in levels of patient satisfaction with primary care. These findings may represent actual differences in quality of care or variations in patient perceptions, patient expectations, and/or questionnaire response styles. More research is needed to assess, in accurate and culturally appropriate ways, whether health plans are meeting the needs of all enrollees.     

Sexuality of nurses: correlations of knowledge, attitudes, and behavior.

In a study of relationships among knowledge, attitudes, and statements of nursing behavior about sexuality, degree of comfort with sexual situations was measured with a Professional Sexual Role Inventory (PSRI), using ridit analysis. The PSRI and the Sex Knowledge and Attitude Test were administered in groups to 107 professional family planning nurses and 64 senior nursing students. The major hypothesis--the more knowledge a nurse has of human sexuality, the more favorable will be her attitude toward it and the more comfortable she will be in professional situations with sexual overtones--was supported. Significant positive correlations between sexual knowledge and attitudes and written responses indicated comfort in handling sexual situations. Analyses of variance of the test scores--by age, race, marital status, religion, religiosity, frequency of church attendance, and urbanization--demonstrated areas of sexuality which might be incorporated into nursing inservice training and education.     

Demographic differences in estimated blood donor eligibility prevalence in the United States

BACKGROUND: The prevalence of blood donor eligibility factors has a major impact on the availability of blood donors and thus the blood supply in the United States. The prevalence of these factors may differ between demographic groups and thus help explain the differences in blood donation rates. STUDY DESIGN AND METHODS: The study population (18‐69 years old who were African American [AA], white, or Hispanic) was 185,073,489. Forty eligibility factors determined by US Food and Drug Administration's Code of Federal Regulations and AABB Standards for Blood Banks and Transfusion Services were used to calculate whole blood donation eligibility rates. Eligibility data were obtained from the 2007 to 2008 National Health and Nutrition Examination Survey, National Ambulatory Medical Care Survey, US Census Bureau, and Centers for Disease Control and Prevention. Eligibility rates were determined by race/ethnicity, sex, and age groups (18‐39 and 40‐69 years). RESULTS: In 2007 to 2008, 122 million Americans (65.9% of the study population and 41.0% of the total US population) were estimated to be eligible to donate blood in the United States. Significant differences in eligibility rates by demographic characterizers were determined (p < 0.001): AAs (36.5%), whites (46.4%), and Hispanics (40.7%); males (45.4%) and females (42.7%); individuals 18 to 39 years old (35.8%); and individuals 40 to 69 years old (32.9%). CONCLUSIONS: AAs were significantly less eligible to donate blood than whites and Hispanics. Disparities in donor eligibility exist by race/ethnicity, sex, and age groups.     

Trends in the rate of depressive illness and use of antidepressant pharmacotherapy by ethnicity/race: an assessment of office-based visits in the United States, 1992-1997

OBJECTIVE: This study was undertaken to determine ethnicity/race-specific (white, black, and Hispanic) population-adjusted rates of US office-based physician visits in which a diagnosis of a depressive disorder was recorded or in which a diagnosis of a depressive disorder was recorded and antidepressant pharmacotherapy was prescribed. METHODS: Data from the National Ambulatory Medical Care Survey for 1992 through 1997 were partitioned into three 2-year periods: 1992-1993, 1994-1995, and 1996-1997. For each 2-year period, data from office-based physician visits for patients aged 20 to 79 years were extracted to assess, by ethnicity/race, (1) the number of visits in which a diagnosis of a depressive illness was recorded (International Classification of Diseases, Ninth Revision, Clinical Modification codes 296.2-296.36, 300.4, or 311) and (2) the number of visits in which a diagnosis of a depressive illness was recorded and antidepressant pharmacotherapy was prescribed. We calculated ethnicity/race-specific rates (per 100 US population aged 20 to 79 years) of office-based visits in which a diagnosis of a depressive disorder was recorded and in which a diagnosis of a depressive disorder was recorded and antidepressant pharmacotherapy was prescribed. The specialty of the reporting physician and the proportion of patients receiving a selective serotonin reuptake inhibitor (SSRI) were also discerned. RESULTS: From 1992-1993 to 1996-1997, the rate of office-based visits (per 100 US population aged 20 to 79 years) in which a diagnosis of a depressive disorder was recorded increased 3.7% for whites (from 10.9 to 11.3; P = 0.001), 31.0% for blacks (from 4.2 to 5.5; P = 0.001), and 72.9% for Hispanics (from 4.8 to 8.3; P = 0.001). The rate of office-based visits in which a diagnosis of a depressive disorder was recorded and antidepressant pharmacotherapy was prescribed increased 18.5% for whites (from 6.5 to 7.7 per 100; P = 0.001), 38.5% for blacks (from 2.6 to 3.6 per 100; P = 0.001). and 106.7% for Hispanics (from 3.0 to 6.2 per 100; P = 0.001). Between 1992-1993 and 1996-1997, use of an SSRI increased among whites and blacks (from 50.0% to 65.8% and from 40.5% to 58.2%, respectively), but declined among Hispanics (from 51.4% to 48.6%; all comparisons P = 0.001). CONCLUSION: By 1996-1997, the population-adjusted rates for Hispanics were within a quartile of those observed for whites, whereas the rates for blacks remained at less than half those observed in whites. The observed divergence in population-adjusted rates by ethnicity/race may reflect the nature of the patient-physician relationship, sensitivity and specificity of diagnostic techniques and instruments, and the wider social context in which an office-based visit occurs, including access to and type of health insurance and coverage for mental health services.     

Data collection with adolescents

Adolescence spans a wide time period during which development and its context influence behaviour and the strategies used for data collection. This article addresses problems that can be anticipated in data collection with adolescents. Problems are presented that are associated with adolescent developmental capacities, adolescent developmental change and stability, gender and ethnicity. Some problems are specific to certain settings or to certain data collection methods. The application of theoretical and empirical knowledge about adolescent development can strengthen data collection instruments and procedures. Strategies to enhance data collection include carefully defining adolescence and tailoring procedures and protocols based on a theoretical understanding of the biological, cognitive and emotional development of adolescents in conjunction with an understanding of the characteristics of the research setting. Adolescent research settings can pose challenges. Investigators must understand clinic routines in evaluating the feasibility of implementing protocols and collecting data where there are distractions and time constraints. In education settings, strategies must be used to collect data in a group context where peer pressure can affect responses. In home settings, ingrained response patterns and family norms can also impede obtaining valid perspectives from adolescents. Ethnicity as well may play an important role that must be addressed when designing and implementing data collection with adolescents. Procedures and instruments selected to collect data need to address variations in ethnicity.     

Focus group interviews as a data collecting strategy

BACKGROUND: Focus group interviews are a method for collecting qualitative data and have enjoyed a surge in popularity in health care research over the last 20 years. However, the literature on this method is ambiguous in relation to the size, constitution, purpose and execution of focus groups. AIM: The aim of this article is to explore some of the methodological issues arising from using focus group interviews in order to stimulate debate about their efficacy. DISCUSSION: Methodological issues are discussed in the context of a study examining attitudes towards and beliefs about older adults in hospital settings among first-level registered nurses, nursing lecturers and student nurses. Focus group interviews were used to identify everyday language and constructs used by nurses, with the intention of incorporating the findings into an instrument to measure attitudes and beliefs quantitatively. CONCLUSIONS: Experiences of conducting focus group interviews demonstrated that smaller groups were more manageable and that groups made up of strangers required more moderator intervention. However, as a data collecting strategy they are a rich source of information.     

Access to care for chronic pain: racial and ethnic differences.

Access to medical care is a major national issue, and several surveys suggest that racial and ethnic differences influence access to care for chronic pain problems. To evaluate the influence of race and ethnicity on access to treatment for chronic pain, a cross-sectional telephone survey was performed in a nationally representative sample of 454 white, 447 African-American, and 434 Hispanic subjects with pain for > or =3 months. Questions explored demographics, pain and its treatment, and perceived access to care. A composite "access" variable combined actual consultation with perceived access. Hispanics were younger, least likely to be insured, and had the least education and lowest income; 61% spoke Spanish at home. Hispanics were significantly less likely to have consulted a primary care practitioner for pain (70%) than whites (84%) or African-Americans (85%). A lower likelihood of consultation also was associated with speaking Spanish, being male, being relatively young (18-34 years old) or single, having limited education, and not being employed. Low "access" to care was associated with being Hispanic and speaking Spanish, being younger or male, having low income or limited education, being employed, and agreeing that financial concerns prevented pain treatment. High "access" was associated with being white or African-American; being older or female or living in a suburban area; having insurance, higher income, or college education; and being unemployed. In multivariate models, low "access" was associated with Hispanic ethnicity and agreement that financial concerns prevented pain treatment. High "access" was associated with more severe pain, having insurance or an income of US 25,000 dollars to US 74,000 dollars, and agreeing that "A doctor or other health care provider is the first person I would go to to discuss my pain." These data suggest that race/ethnicity, other demographic characteristics, and socioeconomic factors influence access to pain care. Hispanic ethnicity predicts limited access. PERSPECTIVE: The influence of race and ethnicity on access to health care is a major issue in the United States. A national telephone survey suggests that race and ethnicity, along with other demographic and socioeconomic factors, influence access to care for chronic pain.     

Patient Race,Ethnicity, Language,and Pain Severity in Primary Care: A Retrospective Electronic Health Record Study

BackgroundPatient race, ethnicity, and culture including language are intertwined and may influence patient reporting of pain severity.PurposeTo describe documentation of patient's self-reported pain presence and severity by race, ethnicity, and language, specifically, Spanish, Hmong, Lao, or Khmer requiring an interpreter or English.Design and SampleRetrospective, electronic health record clinical data mining study of 79,195 patient visits with documented pain scores from one primary care clinic.MethodsHurdle regression was used to explore the effect of race, ethnicity, and language on the chances of having any pain (vs. no pain) and pain severity for visits with pain scores ≥1, controlling for age, sex, and documentation of a pain diagnosis. Mann-Whitney tests were used to explore the influence of English vs. non-English language on pain severity within a race or ethnicity category.ResultsPain scores were higher for limited English proficiency, compared with English-speaking, patients within the Asian race or Hispanic/Latino ethnicity category. Older age, female sex, pain diagnosis, Black or African American race, and Spanish or Lao language increased the chance of having any pain. These same factors, plus American Indian or Alaska Native race, contributed to higher pain severity. Asian race, in contrast, decreased the chance of reporting any pain and contributed to lesser pain severity.ConclusionsRace, in addition to a new area of focus, language, impacted both the chances of reporting any pain and pain severity. Additional research is needed on the impact of language barriers on pain severity reporting, documentation, and differences in pain outcomes and disparities.