Disparities in Hypertension Associated with Limited English Proficiency.
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.


METHODS
Retrospective analysis of multi-year survey data.


METHODS
Adults 18 years of age and older who participated in the NHANES survey during the period 2003-2012.


METHODS
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.


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.
Center for Health Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA. eunjikim@bu.edu.|Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA. eunjikim@bu.edu.
Eun Ji
EJ
Kim
Massachusetts General Hospital, Boston, MA, USA.
Taekyu
T
Kim
Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA.
Michael K
MK
Paasche-Orlow
Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA.
Adam J
AJ
Rose
Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA.|VA Boston Healthcare System, Boston, MA, USA.
Amresh D
AD
Hanchate
D000328:Adult; D003144:Communication Barriers; D005260:Female; D006306:Health Surveys / Q000379:methods; D054625:Healthcare Disparities / Q000208:ethnology / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D007802:Language; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012189:Retrospective Studies; D055815:Young Adult
NHANES; hypertension; language barrier; limited English proficiency