Disparities in Hypertension Associated with Limited English Proficiency

Background: Limited English proficiency (LEP) is associated with poor health status and worse outcomes. Objective: To examine disparities in hypertension between National Health and Nutrition Examination Survey (NHANES) respondents with LEP versus adequate English proficiency. Design: Retrospective analysis of multi-year survey data. Participants: Adults 18 years of age and older who participated in the NHANES survey during the period 2003–2012. Main Measures: We defined participants with LEP as anyone who completed the NHANES survey in a language other than English or with the support of an interpreter. Using logistic regression, we estimated the odds ratio for undiagnosed or uncontrolled hypertension (systolic blood pressure (SBP) > 140 mmHg or diastolic blood pressure (DBP) > 90 mmHg) among LEP participants relative to those with adequate English proficiency. We adjusted for sociodemographic, acculturation-related, and hypertension-related variables. Key Results: Fourteen percent (n = 3,269) of the participants had limited English proficiency: 12.4% (n = 2906) used a Spanish questionnaire and 1.6% (n = 363) used an interpreter to complete the survey in another language. Those with LEP had higher odds of elevated blood pressure on physical examination (adjusted odds ratio [AOR] = 1.47 [1.07–2.03]). This finding persisted among participants using an interpreter (AOR = 1.88 [1.15–3.06]) but not among those using the Spanish questionnaire (AOR = 1.32 [0.98–1.80]). In a subgroup analysis, we found that the majority of uncontrolled hypertension was concentrated among individuals with a known diagnosis of hypertension (AOR = 1.80 [1.16–2.81]) rather than those with undiagnosed hypertension (AOR = 1.14 [0.74–1.75]). Interpreter use was associated with increased odds of uncontrolled hypertension, especially among patients who were not being medically managed for hypertension (AOR = 6.56 [1.30–33.12]). Conclusions: In a nationally representative sample, participants with LEP were more likely to have poorly controlled hypertension than those with adequate English proficiency. LEP is an important driver of disparities in hypertension management and outcomes.