Language barriers lead to underdiagnosis of common atopic conditions

Key takeaways:

• Asthma, eczema and other atopic conditions were diagnosed less often among patients preferring a language other than English.
• The results underscore the need for “appropriate support in this area.”

ANAHEIM, Calif. — Common allergies and immunological conditions may be underdiagnosed by as much as half among patients who face language barriers, according to a poster presentation.

“Among children with a language preference other than English, the diagnosis of asthma was less than half as common, eczema was about two-thirds as common, and other allergic rhinitis was slightly more than half as common when compared with children whose preferred language was English,” Hao Tseng, MD, MSc, pediatric resident at SUNY Downstate Health Sciences University and lead author of the study, said in a press release from the American College of Allergy, Asthma & Immunology. “A similar correlation for the diagnosis of food allergy was deemed not statistically significant.”

To see if those who spoke languages other than English were underdiagnosed for allergic conditions, Tseng and colleagues examined electronic health records for 16,517 children (48.6% girls; 80.4% Black; mean age, 6.2 years) who were seen at a New York primary care pediatric clinic from July 2020 through April 2023. Their rates of diagnosis were analyzed using a logistic regression adjusted for age, sex, race/ethnicity and health insurance.

Languages other than English were preferred by 14.8% of the study population, with Haitian Creole being the most common (4.3%), followed by Spanish (4%) and “other” (6.5%). Also, 78.9% were enrolled in Medicaid.

Results, presented at ACAAI Annual Scientific Meeting, showed the following diagnoses were less common among children who indicated preferring a language other than English:

• asthma (adjusted OR = 0.42; 95% CI, 0.28-0.63);
• penicillin allergy (aOR = 0.51; 95% CI, 0.27-0.96);
• allergic rhinitis (aOR = 0.54; 95% CI, 0.30-0.96); and
• eczema (aOR = 0.69; 95% CI, 0.49-0.96).

Abnormal findings during routine health examinations were also less common among children preferring a language other than English (aOR = 0.8; 95% CI, 0.67-0.94).

Researchers also observed a trend toward reduction in the diagnosis of food allergy (aOR = 0.51; 95% CI, 0.24-1.1) that did not reach statistical significance.

The findings of underdiagnosis among those with potential language barriers highlight “the importance of providing appropriate support in this area,” Tseng and colleagues wrote. They added that further research should explore whether birthplace, cultural practices, environmental exposures and other factors are impacting the results.

Reference:

• Language barriers may cause some children to be underdiagnosed for allergic conditions. https://acaai.org/news/language-barriers-may-cause-some-children-to-be-underdiagnosed-for-allergic-conditions/. Published Nov. 8, 2023. Accessed Nov. 10, 2023.