title: Assessing the relationship between language proficiency and asthma morbidity among inner-city asthmatics.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Division of General Internal Medicine, Mount Sinai School of Medicine, New York, USA. juan.wisnivesky@mssm.edu
authors.forename: Juan P
authors.initials: JP
authors.lastname: Wisnivesky
authors.forename: Meyer
authors.initials: M
authors.lastname: Kattan
authors.forename: David
authors.initials: D
authors.lastname: Evans
authors.forename: Howard
authors.initials: H
authors.lastname: Leventhal
authors.forename: Tamara J
authors.initials: TJ
authors.lastname: Musumeci-Szabó
authors.forename: Thomas
authors.initials: T
authors.lastname: McGinn
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Halm
mesh_terms: D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000208:ethnology*; D015331:Cohort Studies; D003144:Communication Barriers; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003469:Culture; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006306:Health Surveys; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019303:Multilingualism; D009519:New York City; D010817:Physician-Patient Relations; D011446:Prospective Studies; D011788:Quality of Life; D014505:Urban Population / Q000706:statistics & numerical data*; D014600:Utilization Review
chemical_list: D018927:Anti-Asthmatic Agents