Dataset Information

Disparities in Health Insurance Coverage and Access to Care by English Language Proficiency in the USA, 2006-2016.

ABSTRACT:

Background

In the USA, people with limited English proficiency (LEP) disproportionately experience gaps in health insurance coverage and access to care. The Patient Protection and Affordable Care Act (ACA) of 2010 included reforms that could improve these outcomes.

Objective

To describe changes in insurance coverage and access to health care by English language proficiency over 2006-2016.

Design

We used regression models to estimate changes in coverage and access after 2010 for adults with high vs. limited English proficiency, adjusting for socio-economic status, demographic characteristics, and health care needs. We used difference-in-differences models to assess adjusted changes in disparities by English proficiency after 2010. Supplemental analyses used nearest-neighbor propensity score matching to balance the characteristics of respondents.

Participants

Respondents aged 18-64 in the Medical Expenditure Panel Survey over 2006-2016, with high (n = 174,214) or limited (n = 16,484) English language proficiency.

Main measures

Insurance coverage was a binary variable indicating any health insurance coverage during the past 12 months. Access to care was measured using binary variables indicating whether the respondent had a usual source of care and received necessary medical, dental, and preventive care.

Key results

Gains in health insurance coverage after 2010 were significant for adults with high English proficiency (1.7 percentage points, p < 0.001) and adults with limited English proficiency (4.6 percentage points, p = 0.007); gains did not significantly vary by English proficiency. Adults with LEP showed larger improvements than adults with high English proficiency in having a usual source of care (5 percentage points, p = 0.007) and receiving needed medical care and dental care (1.4 percentage points, p = 0.013, and 2.8 percentage points, p = 0.009, respectively). Findings remained similar when matching was used to balance the measured characteristics of respondents with high vs. limited English proficiency.

Conclusions

Disparities in health care access by English proficiency narrowed after 2010, the year of passage of the ACA.

SUBMITTER: Lu T

PROVIDER: S-EPMC7210354 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:BACKGROUND:Limited English proficiency (LEP) is associated with poor health status and worse outcomes. OBJECTIVE:To examine disparities in hypertension between National Health and Nutrition Examination Survey (NHANES) respondents with LEP versus adequate English proficiency. DESIGN:Retrospective analysis of multi-year survey data. PARTICIPANTS:Adults 18 years of age and older who participated in the NHANES survey during the period 2003-2012. MAIN MEASURES:We defined participants with LEP as anyone who completed the NHANES survey in a language other than English or with the support of an interpreter. Using logistic regression, we estimated the odds ratio for undiagnosed or uncontrolled hypertension (systolic blood pressure (SBP)?>?140 mmHg or diastolic blood pressure (DBP)?>?90 mmHg) among LEP participants relative to those with adequate English proficiency. We adjusted for sociodemographic, acculturation-related, and hypertension-related variables. KEY RESULTS:Fourteen percent (n?=?3,269) of the participants had limited English proficiency: 12.4% (n?=?2906) used a Spanish questionnaire and 1.6% (n?=?363) used an interpreter to complete the survey in another language. Those with LEP had higher odds of elevated blood pressure on physical examination (adjusted odds ratio [AOR]?=?1.47 [1.07-2.03]). This finding persisted among participants using an interpreter (AOR?=?1.88 [1.15-3.06]) but not among those using the Spanish questionnaire (AOR?=?1.32 [0.98-1.80]). In a subgroup analysis, we found that the majority of uncontrolled hypertension was concentrated among individuals with a known diagnosis of hypertension (AOR?=?1.80 [1.16-2.81]) rather than those with undiagnosed hypertension (AOR?=?1.14 [0.74-1.75]). Interpreter use was associated with increased odds of uncontrolled hypertension, especially among patients who were not being medically managed for hypertension (AOR?=?6.56 [1.30-33.12]). CONCLUSIONS:In a nationally representative sample, participants with LEP were more likely to have poorly controlled hypertension than those with adequate English proficiency. LEP is an important driver of disparities in hypertension management and outcomes.