Low health literacy, limited English proficiency, and health status in Asians, Latinos, and other racial/ethnic groups in California

Objective. We estimated health status for those with low health literacy and limited-English proficiency alone and in combination for Latino, Chinese, Korean, Vietnamese, and White adults in a population-based sample from California.

Methods. 51,048 adults from the 2007 California Health Interview Survey, including 3,951 with limited-English proficiency, were studied. Multivariate logistic models examined self-reported health by health literacy and English proficiency in both the full sample and racial/ethnic subgroups.

Results. Overall, 44.9% of those with limited-English proficiency reported low health literacy versus 13.8% of English speakers. Among the limited -English proficient, Chinese respondents had the highest prevalence of low health literacy (68.3%), followed by Latinos (45.3%), Koreans (35.6%), Vietnamese (29.6%), and Whites (18.8%). In the full sample, respondents with both limited-English proficiency/low health literacy reported the highest prevalence of poor health (45.1%), followed by limited-English proficiency-only (41.1%), low health literacy-only (22.2%), and neither (13.8%), a hierarchy that remained significant in multivariate models. However, sub-analyses revealed limited-English proficient Latinos, Koreans, and Whites had equal or greater odds of poor health compared with low health literate/limited-English proficient respondents.

Conclusions. Individuals with both limited-English proficiency and low health literacy are at high risk for poor health. Limited-English proficiency may carry greater health risk than low health literacy, though important racial/ethnic variations exist. Public health education and promotion across the lifespan should consider the intersection of health literacy and limited-English proficiency as important factors with individual and combined health consequences.