Heterogeneity of Asthma Care Among Hispanic Subgroups: Lower Utilization of Hospital-based Care among Spanish-speaking Hispanics.

Abstract

Studies found heterogeneity of asthma prevalence among Hispanic subgroups using survey data but addressed under-diagnosis issues due to limited access to health care and diagnosis bias. To examine heterogeneity by language in health care utilization for asthma among Hispanic subgroups. A retrospective, longitudinal cohort study of Medi-Cal claims data (2018-2019) using logistic regression to estimate the odds ratio of health care utilization for asthma. In all, 12,056 (ages 5-64) Hispanics living in Los Angeles were identified as having persistent asthma. Primary language is the predictor variable and outcome measures include ED visits, hospitalizations, and outpatient visits. The odds of ED visits among Spanish-speaking Hispanics were lower than English-speaking Hispanics in the subsequent 6 (95% CI=0.65-0.93) and 12 (95% CI=0.66-0.87) months. Spanish-speaking Hispanics were less likely than their English-speaking counterparts to utilize hospitalization in the 6 months (95% CI=0.48-0.98), while they were more likely to utilize outpatient care (95% CI=1.04-1.24). For Hispanics of Mexican origin, the odds of ED visits among Spanish-speaking Hispanics were also lower in the 6 and 12 months (95% CI=0.63-0.93, 95% CI=0.62-0.83), but their odds of outpatient visits were higher for outpatient visits in the 6 months (95% CI=1.04-1.26). Spanish-speaking Hispanics with persistent asthma were less likely than English-speaking Hispanics to utilize ED visits and hospitalizations but were more likely to utilize outpatient visits. The findings suggest the reduced burden of asthma among the Spanish-speaking Hispanic subgroup and contribute to explaining the protection effect, specifically among Spanish-speaking Hispanics living in highly segregated communities.