The Health Vulnerability of Older Ethnic Immigrants with Limited English Proficiency

Background and Purpose

The number of U.S. residents who have Limited English Proficiency (LEP) has increased substantially, and the health burden of these LEP populations has emerged as a public health concern.  However, the documented disparities may be an underestimation of the broader concern because non-English speakers have often been excluded from research and intervention efforts.  For example, the National Health Interview Survey (NHIS) has language capacity only for English and Spanish, and the vast majority (more than 90%) of respondents completed their interviews in English.  This systematic exclusion of persons with LEP is a serious concern for the diverse Asian American populations whose rates of linguistic isolation are high.  Given that LEP is strongly associated with socioeconomic disadvantages, findings based on English-proficient samples of Asian Americans can render an inaccurate and biased representation.  In recruiting “hard-to-reach” LEP populations, cultural and linguistic sensitivity and community-based approaches are required.  Filling the current knowledge gap, the purpose of the present study was to examine the impact of LEP on health using a sample of older Korean Americans.  The vulnerability of older Korean Americans with LEP in various health outcomes (activity limitations, self-reported health, and probable depression) was assessed in consideration of socio-demographic (age, gender, marital status, education, and financial status) and context (region, length of stay in the U.S., and health insurance) variables.        

Methods

Using pooled data from 1,301 Korean Americans (aged ≥ 60) surveyed in Florida, Texas, and New York during 2008−2013, comparative analyses and multivariate model estimations were conducted.  The selection of sites was designed to reflect the continuum of Korean American population densities.  The community-based samples were collected by a team of investigators who share the same language and culture with the target population.  Conducted in partnerships with ethnic community organizations, the survey questionnaires were in Korean and included questions on English proficiency, physical activities of daily living (PADL; Fillenbaum, 1988), self-rated health, and symptoms of depression (CES-D; Andresen, Malmgren, Carter, & Patrick, 1994, Radloff, 1977).    

Results

More than 70% of the sample exhibited LEP.  The LEP group presented more adverse socio-demographic and health profiles compared to their English speaking counterparts.  A series of logistic regression models showed that persons with LEP were 2.72 times more likely to have activity limitations, 2.59 times more likely to report poor/fair health, and 1.73 times more likely to have probable depression. 

Conclusions and Implications

Findings identified LEP as a major source of health disparity and underscore the importance of LEP as an intervening agent in health planning and interventions for older ethnic minority populations.