Patient-Physician Language Concordance and Primary Care Screening Practices among Spanish-Speaking Patients

BACKGROUND: Compared to non-Hispanic white and blacks, Hispanic patients are less likely to undergo cervical, breast, and colorectal cancer screening. Furthermore, Spanish-speaking Hispanics are less likely to be screened for hyperlipidemia than English-speaking Hispanics. We sought to determine whether patient-physician language concordance was associated with differences in cancer and cardiovascular risk factor screening.

METHODS: We performed a retrospective medical record review and identified 306 Spanish-speaking patients age 35-75 who used interpreter services between June 2001 to June 2006 in two Boston-based primary care practices. Our outcomes included screening for hyperlipidemia, diabetes, cervical cancer, breast cancer, and colorectal cancer with age- and sex-appropriate subgroups, as recommended by U.S. Preventive Services Task Force. Our main predictor of interest was patient-physician language concordance. In our multivariable modeling, we included age, sex, weight, insurance status, number of PCP visits, and comorbidities.

RESULTS: After multivariable adjustment, rates of screening for hyperlipidemia, diabetes, cervical cancer, and breast cancer were similar for both language concordant and language discordant groups. However, patients in the language concordant group were less likely to be screened for colorectal cancer compared to the language discordant group after multivariable adjustment [odds ratio (OR)=0.35, CI 0.18-0.70]. Odds ratios did not change significantly with adjusting for clustering by generalized estimating equations.

CONCLUSIONS: Although matching bilingual PCPs to patients with limited English proficiency has been touted to improve patient care, this study finds that Spanish-speaking patients cared for by language-concordant PCPs were not more likely to receive recommended screening for cardiovascular risk factors and cancer.