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Article: Assessing the Relationship Between Language Proficiency and Asthma Morbidity Among Inner-City Asthmatics

Saturday, February 07, 2009

  • Wisnivesky, Juan P. MD, MPH*†; Kattan, Meyer MD‡; Evans, David PhD‡; Leventhal, Howard PhD §; Musumeci-Szabó, Tamara J. PhD§; McGinn, Thomas MD, MPH*; Halm, Ethan A. MD, MPH*¶
  • Medical Care:Volume 47(2)February 2009pp 243-249


Background: Patient-provider communication is essential for high-quality asthma care. The objective of this study was to assess the potential relationship of language barriers with outcomes of inner-city asthmatics.

Research Design: We interviewed a prospective cohort of 318 adults with persistent asthma receiving care at 2 large inner-city clinics. Patients were classified into 3 groups according to their English proficiency; non-Hispanics (all native English speakers), Hispanics proficient in English, and Hispanics with limited English proficiency. Data on asthma control (Asthma Control Questionnaire), resource utilization, and asthma-related quality of life (Asthma Quality of Life Questionnaire) were collected at 1 and 3 months of enrollment. Univariate and multiple regression analyses were used to compare asthma morbidity and quality of life according to the patients' level of English proficiency.

Results: Overall, 44% of patients were non-Hispanics, 38% were Hispanics proficient in English, and 18% were Hispanics with limited English proficiency. Unadjusted, stratified, and multivariate analyses showed a significant association between limited proficiency and poorer asthma control, increased resource utilization, and lower quality of life scores after controlling for potential confounders (P < 0.05 for all comparisons). Additionally, limited English proficiency was associated with increased worries about side effects or becoming addicted to inhaled corticosteroids, beliefs that asthma is an acute disease, decreased self-efficacy, and lower adherence rates.

Conclusions: Inner-city asthmatics with limited English proficiency have significantly poorer asthma control, higher rates of resource utilization, and a lower quality of life. Further research is necessary to understand the mechanisms underlying this association.
© 2009 Lippincott Williams & Wilkins, Inc.

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