Assessing the relationship between language proficiency and asthma morbidity among inner-city asthmatics

Background: Patient-provider communication is essential for high-quality asthma care. The objective of this study was to assess the potential relationship of language barriers with outcomes of inner-city asthmatics. Research Design: We interviewed a prospective cohort of 318 adults with persistent asthma receiving care at 2 large inner-city clinics. Patients were classified into 3 groups according to their English proficiency; non-Hispanics (all native English speakers), Hispanics proficient in English, and Hispanics with limited English proficiency. Data on asthma control (Asthma Control Questionnaire), resource utilization, and asthma-related quality of life (Asthma Quality of Life Questionnaire) were collected at 1 and 3 months of enrollment. Univariate and multiple regression analyses were used to compare asthma morbidity and quality of life according to the patients' level of English proficiency. Results: Overall, 44% of patients were non-Hispanics, 38% were Hispanics proficient in English, and 18% were Hispanics with limited English proficiency. Unadjusted, stratified, and multivariate analyses showed a significant association between limited proficiency and poorer asthma control, increased resource utilization, and lower quality of life scores after controlling for potential confounders (P < 0.05 for all comparisons). Additionally, limited English proficiency was associated with increased worries about side effects or becoming addicted to inhaled corticosteroids, beliefs that asthma is an acute disease, decreased self-efficacy, and lower adherence rates. Conclusions: Inner-city asthmatics with limited English proficiency have significantly poorer asthma control, higher rates of resource utilization, and a lower quality of life. Further research is necessary to understand the mechanisms underlying this association.