Colorectal Cancer Screening: Low Health Literacy and Limited English Proficiency Among Asians and Whites in California

Abstract

The authors examined the relationship between low health literacy (LHL), limited English proficiency (LEP), and meeting current U.S. Preventive Service Task Force colorectal cancer (CRC) screening guidelines for Asians and Whites in California. For 1,478 Asian and 14,410 White respondents 50–75 years of age in the 2007 California Health Interview Survey, the authors examined meeting CRC screening guidelines using multivariable logistic models by LEP and LHL separately and in combination. Analyses were run with the full sample, then separately for Whites and Asians controlling for demographics and insurance. For those with LEP, patient-provider language concordance and CRC screening was examined. Overall, respondents with LEP and LHL were the least likely to meet CRC screening guidelines (36%) followed by LEP-only (45%), LHL-only (51%), and those with neither LHL nor LEP (59%), a hierarchy that remained significant in multivariable models. For Whites, LHL-only was associated with screening, whereas LEP-only and LEP and LHL were significant for Asians. Having a language concordant provider was not significantly associated with CRC screening among those with LEP. Health literacy is associated with CRC screening, but English proficiency is also critical to consider. Asians with both LEP and LHL appear particularly vulnerable to cancer screening disparities.

Acknowledgments

This study was supported by National Cancer Institute grants no. 1R03CA158419 and U54CA153459. Biostatistical support was also partially supported by grants from the National Institute on Minority Health and Health Disparities U54MD007584 and G12MD007601 from the National Institutes of Health.

Notes

Note. Numbers are weighted to account for the complex survey design and to present a representative sample of the California population. Totals may not equal 100% because of rounding.

^a Unweighted N.

^b Unweighted n.

LEP = Limited English proficiency; LHL = low health literacy. < /T.

Note. LEP = Limited English proficiency; LHL = low health literacy; N/A = variable could not be included due to insufficient cases for analysis.