Language spoken and differences in health status, access to care, and receipt of preventive services among US Hispanics

Objectives. We examined self-reported health status, health behaviors, access to care, and use of preventive services of the US Hispanic adult population to identify language-associated disparities.Methods. We analyzed 2003 to 2005 Behavioral Risk Factor Surveillance System data from 45 076 Hispanic adults in 23 states, who represented 90% of the US Hispanic population, and compared 25 health indicators between Spanish-speaking Hispanics and English-speaking Hispanics.Results. Physical activity and rates of chronic disease, obesity, and smoking were significantly lower among Spanish-speaking Hispanics than among English-speaking Hispanics. Spanish-speaking Hispanics reported far worse health status and access to care than did English-speaking Hispanics (39% vs 17% in fair or poor health, 55% vs 23% uninsured, and 58% vs 29% without a personal doctor) and received less preventive care. Adjustment for demographic and socioeconomic factors did not mitigate the influence of language on these health indicators.Conclusions. Spanish-language preference marks a particularly vulnerable subpopulation of US Hispanics who have less access to care and use of preventive services. Priority areas for Spanish-speaking adults include maintenance of healthy behaviors, promotion of physical activity and preventive health care, and increased access to care.More than 1 in 10 US residents now speak Spanish at home, and approximately half of these persons report an ability to speak English less than “very well.”¹ Language preference and English language proficiency have previously been associated with health-related behaviors, disease prevalence, and receipt of health care services among Hispanics,^2–6 but lack of sufficient individual-level population-based data on ethnicity, socioeconomic position, acculturation, and language has limited our ability to document the extent of language-associated disparities or to understand their component causes.⁷The utility of national surveys in monitoring health disparities and informing public health interventions relies upon methodologic adaptation to the increasing diversity of the US population.⁸ One of the most important sources of national data for identifying emerging health problems, developing public health policies and targeted prevention programs, and tracking progress toward meeting the Healthy People 2010 objectives is the Behavioral Risk Factor Surveillance System (BRFSS) sponsored by the Centers for Disease Control and Prevention.⁹ The BRFSS has included an optional Spanish-language survey instrument since 1987, but until recently, few states conducted Spanish-language interviews. Spanish-language survey data are now available from 23 states, which together represent approximately 90% of the total US Hispanic population. Thus, it is newly possible to describe rates of common population health indicators for a nationally representative sample of Spanish-speaking adults and to broadly examine language-associated disparities within the US Hispanic population.We sought to (1) provide a broad, national overview of the current US Spanish-speaking population, examining chronic disease prevalence, risk factors, self-reported health status, access to care, and receipt of preventive health services; (2) assess the extent to which language is associated with these health indicators among US Hispanics; and (3) examine regional variation in these health indicators among Spanish-speaking Hispanics. Comparative indicators for English-speaking Hispanic respondents are given to provide a context for evaluating and responding to the health risks and health care needs of the Spanish-speaking population.