title: Language barriers, physician-patient language concordance, and glycemic control among insured Latinos with diabetes: the Diabetes Study of Northern California (DISTANCE).
abstract: BACKGROUND
  A significant proportion of US Latinos with diabetes have limited English proficiency (LEP). Whether language barriers in health care contribute to poor glycemic control is unknown.
  
  
  OBJECTIVE
  To assess the association between limited English proficiency (LEP) and glycemic control and whether this association is modified by having a language-concordant physician.
  
  
  METHODS
  Cross-sectional, observational study using data from the 2005-2006 Diabetes Study of Northern California (DISTANCE). Patients received care in a managed care setting with interpreter services and self-reported their English language ability and the Spanish language ability of their physician. Outcome was poor glycemic control (glycosylated hemoglobin A1c > 9%).
  
  
  RESULTS
  The unadjusted percentage of patients with poor glycemic control was similar among Latino patients with LEP (n = 510) and Latino English-speakers (n = 2,683), and higher in both groups than in whites (n = 3,545) (21% vs 18% vs. 10%, p < 0.005). This relationship differed significantly by patient-provider language concordance (p < 0.01 for interaction). LEP patients with language-discordant physicians (n = 115) were more likely than LEP patients with language-concordant physicians (n = 137) to have poor glycemic control (27.8% vs 16.1% p = 0.02). After controlling for potential demographic and clinical confounders, LEP Latinos with language-concordant physicians had similar odds of poor glycemic control as Latino English speakers (OR 0.89; CI 0.53-1.49), whereas LEP Latinos with language-discordant physicians had greater odds of poor control than Latino English speakers (OR 1.76; CI 1.04-2.97). Among LEP Latinos, having a language discordant physician was associated with significantly poorer glycemic control (OR 1.98; CI 1.03-3.80).
  
  
  CONCLUSIONS
  Language barriers contribute to health disparities among Latinos with diabetes. Limited English proficiency is an independent predictor for poor glycemic control among insured US Latinos with diabetes, an association not observed when care is provided by language-concordant physicians. Future research should determine if strategies to increase language-concordant care improve glycemic control among US Latinos with LEP.
authors.affiliation: Department of Medicine, University of California, San Francisco, CA, USA. afernandez@medsfgh.ucsf.edu
authors.forename: Alicia
authors.initials: A
authors.lastname: Fernandez
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
authors.forename: E Margaret
authors.initials: EM
authors.lastname: Warton
authors.forename: Nancy
authors.initials: N
authors.lastname: Adler
authors.forename: Howard H
authors.initials: HH
authors.lastname: Moffet
authors.forename: Yael
authors.initials: Y
authors.lastname: Schenker
authors.forename: M Victoria
authors.initials: MV
authors.lastname: Salgado
authors.forename: Ameena
authors.initials: A
authors.lastname: Ahmed
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Karter
mesh_terms: D000368:Aged; D002140:California / Q000208:ethnology; D003144:Communication Barriers; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000208:ethnology* / Q000628:therapy; D005260:Female; D038321:Glycemic Index / Q000502:physiology; D006630:Hispanic or Latino / Q000208:ethnology*; D006801:Humans; D007348:Insurance, Health; D007802:Language; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D012042:Registries