Primary Language Spoken at Home and Health and Healthcare Disparities in US Adolescents: Has the Tincture of Time Reduced Disparities?

Background: Little is known about disparities and their trends over time in youth from non-English-primary-language (NEPL) homes compared with youth from English-primary-language (EPL) homes, and even less is known about disparities in NEPL youth.

Methods: The National Survey of Children's Health, conducted by the National Center for Health Statistics, was a random-digit-dial phone survey in 2003 and 2007 of nationally representative samples of households with children 0-17 years old. Bivariable and multivariable analyses were performed for all youth 10-17 years old to identify disparities in 40 measures of medical and oral health, access to care, and use of services. Among NEPL youth, sub-analyses compared Latinos (Ls), Asian/Pacific Islanders (APIs), and whites. Z-scores were used to analyze time trends in disparities from 2003-2007 (significance tested at α<.05).

Results: Data were available on 94,729 youth in both survey waves. In multivariable analyses adjusting for eight sociodemographic factors, NEPL (vs. EPL) youth in 2007 had significantly greater adjusted odds of suboptimal medical and oral health status, no medical insurance, no personal doctor/nurse (PDN), and no specialist and routine preventive dental visit in the past year. In a 2007 sub-analysis, compared with NEPL white youth, NEPL Latinos had greater odds of suboptimal medical [odds ratio (OR), 4.8; 95% confidence interval (CI), 2.5-9.9] and oral health [OR, 2.4; 95% CI, 1.1-5.4], no medical insurance [OR, 2.7; 95% CI, 1.1-6.5], and unmet dental care needs [OR, 16.2; 95% CI, 1.7-154.1]; NEPL APIs had greater odds of no mental health visit in the past year [OR, 7.2; 95% CI, 1.4-36.3]; and NEPL Latinos and APIs had greater odds of no PDN [OR, 3.9; 95% CI, 1.5-10.1; OR, 5.7; 95% CI, 1.4-22.8] and no preventive dental care in the past year [OR, 4.7; 95% CI, 1.4-15.4; OR, 4.4; 95% CI, 1.2-16.1]. Almost all disparities for NEPL youth (vs. EPL youth) persisted between 2003 and 2007. Two disparities significantly worsened: NEPL vs. EPL youth needing more medical care than others, and for NEPL Latinos vs. whites, having ADHD.

Conclusion: NEPL youth experience multiple disparities in medical and oral health, access to care, and use of health services, and almost all disparities persisted over time. Compared with NEPL white youth, NEPL Latinos and APIs also face many disparities, most of which have continued over time. Results of this study may help guide policy to improve health and healthcare disparities in NEPL youth, including reducing language barriers.