Household language use and health care access, unmet need, and family impact among CSHCN.

OBJECTIVES: We examined the association of household language use and access to care among children with special health care needs (CSHCN). From this study we describe the demographics of children and the prevalence of selected access characteristics according to their primary household language and examine the independent effects of household language on health care access, unmet needs, and family impact while controlling for confounding variables.

METHODS: Data from the 2005-2006 National Survey of Children With Special Health Care Needs, a nationally representative telephone survey of 40,723 CSHCN, were analyzed. Bivariate and multivariable analyses were used to examine disparities and estimate adjusted odds ratios of health care access, satisfaction, and family-impact measures for CSHCN from non-English-primary-language (NEPL) versus English-primary-language (EPL) households.

RESULTS: Nearly 14% of all US children live in NEPL households. NEPL CSHCN were significantly more likely to be Hispanic or other race, be poor, have less educated parents, and reside in metropolitan areas and larger households and yet were less likely to be on cash assistance from welfare. Logistic regression showed that NEPL CSHCN were twice as likely to lack access to a medical home, a usual source of care, and family-centered care. They were 4 times as likely to lack health insurance, and their family members were also more likely to lack adequate insurance. Family members of NEPL children were almost twice as likely to have to stop employment as a result of their child's condition.

CONCLUSIONS: Although limited by program eligibility contingent on immigrant status and state policies, increased referrals to programs such as the State Children's Health Insurance Program and Medicaid can improve access while utilization can be improved by the availability of interpreters, community health workers, linguistically concordant providers, and outreach education efforts of NEPL parents.