Language barrier increases health care use in children with asthma

Key takeaways:

• Caregiver non-English language preference is associated with increased health care usage by children with asthma.
• The disparity was especially noticeable among children with Hispanic-identifying caregivers.

Children with asthma were more likely to be hospitalized for asthma-related health issues if their caregiver had a non-English language preference, according to a study published in Pediatrics.

“Asthma morbidity is disproportionality high in historically marginalized racial and ethnic communities,” Mickey Emmanuel, MD, an emergency medicine physician at Children’s National Hospital in Washington, D.C., told Healio. “Families that speak languages other than English can have additional barriers to quality health care related to navigating the health care system and communicating with their providers.”

The aim of the new study, Emmanuel said, was to determine the relationship between caregiver non-English language preference and asthma-related ED visits, hospitalizations and ICU visits.

“Non-English language preference has been associated with increased patient safety issues and worse health outcomes in other disease processes, but few studies have looked at the role of caregiver language preference and pediatric asthma outcomes,” Emmanuel said.

Using data from the DC Pediatric Asthma Registry, Emmanuel and colleagues analyzed the electronic medical records of 14,431 patients with asthma at Children’s National Hospital during and before the year 2019, with patients ranging in age from 2 to 17 years.

Among the 8.1% of caregivers who had a non-English language preference, their children were more likely to have unscheduled asthma-related ED visits (adjusted OR = 1.37; 95% CI, 1.08-1.74) hospitalizations (aOR = 1.79; 95% CI, 1.18-2.72) or ICU visits (aOR = 4.37; 95% CI, 1.93-9.92). This remained true after controlling for age, ethnicity, insurance status, diagnosis of persistent asthma, controller prescription and encounter with a primary care provider.

In a Hispanic subgroup totaling 1,555 patients, children of caregivers with non-English language preference were more likely to have an asthma-related hospitalization (aOR = 1.73; 95% CI, 1.02-2.93).

Caregivers with non-English language preference were just as likely to have a primary care provider visit and were more likely to have a controller prescription compared with caregivers with an English preference.

“In the context of these demographic findings, it was surprising that non-English language preference was associated with not only increased asthma-related ED visits, but also with hospitalizations and ICU visits,” Emmanuel said. “This indicates that caregiver language preference was a significant determinant for asthma-related health care utilization.”

Emmanuel said it is important for providers and pediatricians to recognize that caregiver language can significantly contribute to asthma morbidity.

“Future studies should focus on both qualitative and quality improvement work to determine barriers to care from a patient and family perspective, as well as work toward solutions to improving care in the ambulatory and hospital-based environment,” Emmanuel said. “Innovative solutions that put the family needs and beliefs at the center are of utmost importance.”