Delayed and forgone health care among adults with limited english proficiency during the early COVID-19 pandemic


Background:Individuals with limited English proficiency (LEP) have long faced barriers in navigating the health care system. More information is needed to understand whether their care was limited further during the early period of the COVID-19 pandemic.

Objective:To assess the impact of English proficiency on delayed and forgone health care during the early COVID-19 pandemic.

Research design:Multivariate logistic regression analysis of National Health Interview Survey data (July-December 2020; n=16,941). Outcomes were self-reported delayed and forgone health care because of cost or the COVID-19 pandemic. Delayed health care included medical, dental, mental health, and pharmacy care. Forgone health care also included care at home from a health professional.

Results:A greater percentage of LEP adults reported delayed (49%) and forgone (41%) health care than English-proficient adults (40% and 30%, respectively). However, English proficiency was not significantly associated with delayed or forgone health care, after adjusting for demographic, socioeconomic, and health factors. Among LEP adults, multivariate models showed that being uninsured, having a disability, and having chronic conditions increased the risk of delaying and forgoing health care. LEP adults of Asian race and Hispanic ethnicity were also more likely to forgo health care while those with 65+ years were less likely to forgo health care.

Conclusions:Adults with LEP were more likely to experience challenges accessing health care early in the pandemic. Delayed and forgone health care were explained by low socioeconomic status and poor health. These findings highlight how during a period of limited health resources, deficiencies in the health care system resulted in an already disadvantaged group being at greater risk of inequitable access to care.

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