Low Health Literacy, Limited English Proficiency, and Health Status in Asians, Latinos, and Other Racial/Ethnic Groups in California

Abstract

This study estimated health status by low health literacy and limited English proficiency alone and in combination for Latino, Chinese, Korean, Vietnamese, and White respondents in a population-based sample: 48,427 adults from the 2007 California Health Interview Survey, including 3,715 with limited English proficiency. Multivariate logistic models examined self-reported health by health literacy and English proficiency in the full sample and in racial/ethnic subgroups. Overall, 44.9% 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 (29.7%), 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, subanalyses revealed that limited English proficient Latinos, Vietnamese, and Whites had equal or greater odds of poor health compared with low health literate/limited English proficient respondents. 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.

Acknowledgments

This research was partially supported by U54CA153459 and R03CA158419 from the National Cancer Institute.

Notes

Note. Within only those with Limited English Proficiency (LEP), all chi-square comparisons of study factors across the six racial/ethnic groups are significant at the p < .05 level except female, which does not significantly vary across racial/ethnic groups. Similarly, within only those who have English proficiency, all chi-square comparisons of study factors across the six racial/ethnic groups are significant at the p < .05 level except female, which does not significantly vary across racial/ethnic groups. Numbers are weighted to account for the complex survey design and to present a representative sample of the California population. “Other” race/ethnicity category includes all racial/ethnic groups who lack sufficient LEP sample sizes (<100) to analyze separately, including Black, Japanese, and Filipino respondents.

^a Unweighted n..

^b Weighted % total.

^c Weighted % within race/ethnicity.

Note. CHIS = California Health Interview Survey. LEP = limited English proficiency. All group comparisons are significant at the level of p < .001 from chi-square analyses.

Note. CHIS = California Health Interview Survey. LEP = limited English proficiency. Bold values are statistically significant.