Published online June 2, 2008
PEDIATRICS Vol. 121 No. 6 June 2008, pp. e1703-e1714 (doi:10.1542/peds.2007-2906)
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ARTICLE

The Language Spoken at Home and Disparities in Medical and Dental Health, Access to Care, and Use of Services in US Children

Glenn Flores, MDa,b and Sandra C. Tomany-Korman, MSc

a Division of General Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
b Children's Medical Center, Dallas, Texas
c Signature Science, LLC, Austin, Texas

BACKGROUND AND OBJECTIVE. Fifty-five million Americans speak a non-English primary language at home, but little is known about health disparities for children in non-English-primary-language households. Our study objective was to examine whether disparities in medical and dental health, access to care, and use of services exist for children in non-English-primary-language households.

METHODS. The National Survey of Childhood Health was a telephone survey in 2003–2004 of a nationwide sample of parents of 102 353 children 0 to 17 years old. Disparities in medical and oral health and health care were examined for children in a non-English-primary-language household compared with children in English- primary-language households, both in bivariate analyses and in multivariable analyses that adjusted for 8 covariates (child's age, race/ethnicity, and medical or dental insurance coverage, caregiver's highest educational attainment and employment status, number of children and adults in the household, and poverty status).

RESULTS. Children in non-English-primary-language households were significantly more likely than children in English-primary-language households to be poor (42% vs 13%) and Latino or Asian/Pacific Islander. Significantly higher proportions of children in non-English-primary-language households were not in excellent/very good health (43% vs 12%), were overweight/at risk for overweight (48% vs 39%), had teeth in fair/poor condition (27% vs 7%), and were uninsured (27% vs 6%), sporadically insured (20% vs 10%), and lacked dental insurance (39% vs 20%). Children in non-English-primary-language households more often had no usual source of medical care (38% vs 13%), made no medical (27% vs 12%) or preventive dental (14% vs 6%) visits in the previous year, and had problems obtaining specialty care (40% vs 23%). Latino and Asian children in non-English-primary-language households had several unique disparities compared with white children in non-English-primary-language households. Almost all disparities persisted in multivariable analyses.

CONCLUSIONS. Compared with children in English-primary-language households, children in non-English-primary-language households experienced multiple disparities in medical and oral health, access to care, and use of services.

Key Words: disparities • language • communication barriers • children • Hispanics • Asians/Pacific Islanders • minorities

Abbreviations: NEPL—non-English primary language spoken at home • NSCH—National Survey of Children's Health • MCHB—Maternal and Child Health Bureau • CI—confidence interval • EPL—English primary language spoken at home • API—Asian/Pacific Islander • OR—odds ratio • OARO—overweight/at risk for overweight • USC—usual source of care • ED—emergency department • ADHD—attention-deficit/hyperactivity disorder • LEP—limited English proficiency

Accepted Jan 2, 2008.