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BACKGROUND: Hispanics are the fastest growing ethnic minority in Texas (40.8%), almost reaching equal proportions as non-Hispanic whites (42.8%) in 2013. Several studies have reported health disparities among Hispanics at national level by their language preference and English language proficiency. Our study examined differences related to chronic diseases, behavioral risk factors and healthcare access among Hispanics by their survey language preference (Spanish vs. English) in Texas.
METHODS: Texas 2013 Behavioral Risk Factor Surveillance System data were analyzed. The analysis was restricted to 3,186 Hispanics among the total 10,917 adults aged >18 years who responded to the survey and were categorized as Spanish-preferring and English-preferring. Chi-square tests were used to determine association between language preference of the survey respondent and 18 health indicators; cancer, high cholesterol, chronic obstructive pulmonary disease (COPD), heart disease, stroke, arthritis, diabetes, asthma, high blood pressure, obesity, smoking, binge drinking, physical activity, lack of health insurance, cost as barrier to seek medical care, no routine check-up in past year, not having personal doctor, and activity limitation. Weighted logistic regression was conducted using SAS 9.3 for each indicator controlling for age, education and income to estimate Odds Ratios (OR) and 95% confidence interval for Spanish-preferring Hispanics as compared to English-preferring Hispanics.
RESULTS: Descriptive analysis showed that age, income and education were significantly different among Hispanics by their preferred language. Spanish-preferring Hispanic respondents were older than English-preferring counterparts (76.3% vs. 53.9% were 30-64 years), more frequently reported less than $25,000 as annual income (70% vs. 39.3%) and were less educated (3.5 % vs. 13.4% for college graduation). Logistic regression models showed that odds of having stroke (OR: 0.20, 95% CI: 0.04, 0.9), asthma (OR: 0.20, 95% CI: 0.1, 0.5), activity limitation (OR: 0.24, 95% CI: 0.2, 0.4), and being a current smoker (OR: 0.46, 95% CI: 0.3, 0.7) were significantly lower among Spanish-preferring Hispanics as compared to English-preferring Hispanics. However, Spanish-preferring Hispanics had roughly twice the odds of lacking health insurance (OR: 1.96, 95% CI: 1.4, 2.7) and a personal doctor (OR: 1.87, 95% CI: 1.4, 2.6).
CONCLUSIONS: Spanish-preferring Hispanics reported far less education and income and were less likely to have some chronic diseases and risk factors as compared to English-preferring Hispanics. However, they reported worse access to care indicators. These results may indicate that Spanish-preferring Hispanics may be underdiagnosed for having chronic conditions or the possibility that the English-preferring Hispanics share a greater burden of some chronic diseases among Hispanics.