Primary language and receipt of recommended health care among Hispanics in the United States

Background: Disparities in health care services between Hispanics and whites in the United States are well documented. Objective: The objective of the study was to determine whether language spoken at home identifies Hispanics at risk for not receiving recommended health care services. Design. The design of the study was cross-sectional, nationally representative survey of households. Patients: The patients were non-Hispanic white and Hispanic adults participating in the 2003 Medical Expenditure Panel Survey. Measurements: We compared receipt of ten recommended health care services by ethnicity and primary language adjusting for demographic and socioeconomic characteristics, health status, and access to care. Results: The sample included 12,706 whites and 5,500 Hispanics. In bivariate comparisons, 57.0% of whites received all eligible health care services compared to 53.6% for Hispanics who spoke English at home, 44.9% for Hispanics who did not speak English at home but who were comfortable speaking English, and 35.0% for Hispanics who did not speak English at home and were uncomfortable speaking English (p <.001). In multivariate logistic models, compared to non-Hispanic whites, Hispanics who did not speak English at home were less likely to receive all eligible health care services, whether they were comfortable speaking English (risk ratio [RR] 0.88, 95% confidence interval [CI] 0.74-0.97) or not (RR 0.84, 95% Cl 0.68-0.95). Conclusions: Speaking a language other than English at home identified Hispanics at risk for not receiving recommended health care services, whether they were comfortable in speaking English or not. Identifying the mechanism for disparities by language usage may lead to interventions to reduce ethnic disparities.