Disparate Use of Diagnostic Modalities for Patients With Limited English Proficiency and Neurologic Disorders

Background and objectives: Limited English proficiency (LEP) impairs health access-including outpatient specialty care-and quality care, i.e., inappropriate use of diagnostic tests. At least in some cases, studies have suggested that clinicians may substitute testing for time-consuming clinical evaluation involving medical interpreters. This study (1) examines disparities in receipt of diagnostic testing among patients with LEP and neurologic illness, in both the ambulatory and emergency department (ED) settings, including (2) whether better patient-provider communication is associated with reduced testing disparities and (3) how testing disparities vary according to insurance.

Methods: We analyzed nationally representative data from the 2003-2018 Medical Expenditure Panel Survey and identified adults with neurologic illness using diagnostic codes. To assess the association between LEP status and diagnostic testing (CT/MRI, laboratory tests, and any diagnostic tests), we estimated logistic regression models that included year-fixed effects. We constructed separate models for ambulatory and ED settings, including models with a patient-provider communication measure to see how that influenced the LEP-diagnostic testing association. Finally, we conducted stratified analyses by sources of health insurance.

Results: LEP status was associated with greater receipt of laboratory tests (OR = 1.46, p < 0.05) but less CT/MRI in the ambulatory setting (0.86, p < 0.05), patterns that persisted in analyses stratified by insurance status. Factoring in patient-provider communication attenuated but did not eliminate these disparities, with attenuation most notable in rates of CT/MRI. We found fewer testing disparities for patients with LEP in the ED than in ambulatory settings.

Discussion: In this nationwide study of patients with neurologic illness, we observed both greater and less use of diagnostic tests for patients with LEP and neurologic illness. The greater use of laboratory tests may reflect the overuse of easily obtainable tests for patients with LEP. Conversely, the less use of CT/MRI may be due to time and transportation challenges in scheduling follow-up visits, alongside other barriers to patient follow-up. The population of patients with LEP is growing, making it critical to study not only disparities in their care but also nuances and determinants of these disparities beyond patient-provider communication and across clinical settings.