• Juan P Wisnivesky, Meyer Kattan, David Evans, Howard Leventhal, Tamara J Musumeci-Szabó, Thomas McGinn, and Ethan A Halm.
• Division of General Internal Medicine, Mount Sinai School of Medicine, New York, USA. juan.wisnivesky@mssm.edu
• Med Care. 2009 Feb 1; 47 (2): 243-9.

BackgroundPatient-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 DesignWe 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.ResultsOverall, 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.ConclusionsInner-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.

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