Predicted Health Literacy Disparities Between Immigrant and US-Born Racial/Ethnic Minorities: a Nationwide Study

Aryana Sepassi; Samantha Garcia; Sora Tanjasiri; Sunmin Lee; Mark Bounthavong

doi:10.1007/s11606-023-08082-x

Predicted Health Literacy Disparities Between Immigrant and US-Born Racial/Ethnic Minorities: a Nationwide Study

J Gen Intern Med. 2023 Aug;38(10):2364-2373. doi: 10.1007/s11606-023-08082-x. Epub 2023 Feb 27.

Authors

Aryana Sepassi¹, Samantha Garcia^{2

3}, Sora Tanjasiri⁴, Sunmin Lee⁵, Mark Bounthavong^{6

7}

Affiliations

¹ Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, 802 W Peltason Dr., Irvine, CA, 92617, USA. asepassi@hs.uci.edu.
² Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.
³ Keck School of Medicine, Los Angeles, CA, USA.
⁴ Department of Epidemiology & Biostatistics, Program of Public Health, University of California, Irvine, Irvine, CA, USA.
⁵ Department of Medicine, School of Medicine, University of California, Irvine, Irvine, CA, USA.
⁶ Division of Clinical Pharmacy, Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, USA.
⁷ Department of Veteran Affairs, Health Economic Resource Center, Menlo Park, CA, USA.

Abstract

Background: Racial/ethnic minorities in the USA exhibit reduced health literacy (HL) proficiency, leading to increased health disparities. It is unclear how the effect of birth status (immigrant/US-born) affects HL proficiency among racial/ethnic minorities.

Objective: To identify the direct, indirect, and total effects of birth status on HL proficiency among a nationally representative population of racial/ethnic minority adults in the USA.

Design: A cross-sectional study of 2019 data from the Medial Expenditure Panel Survey.

Participants: Participants aged 18 or older reporting as racial/ethnic minorities (Black, Asian, or Hispanic) with non-missing data.

Main measures: We predicted HL proficiency for each participant using a previously published model. Path analysis was used to estimate the direct, indirect, and total effects of birth status on HL proficiency, accounting for several other covariates. Prevalence ratios were estimated using adjusted Poisson regression to evaluate differences in the "Below Basic" HL category.

Key results: An estimated weighted 81,092,505 participants were included (57.5% US-born, 42.5% immigrant). More racial/ethnic minority immigrant participants fell into the lowest category of HL proficiency, "Below Basic" (14.3% vs 5.5%, p < 0.05). Results of the path analysis indicated a significant, negative direct effect of birth status on HL proficiency (standardized coefficient = - 0.24, SE = 0.01, 95%CI: - 0.26, - 0.23) in addition to an indirect effect mediated through insurance status, health-system resource use, and English proficiency. The total effect of birth status on HL proficiency was found to be - 0.29. The immigrant participant group had 81% higher prevalence of falling into the "Below Basic" HL category compared to US-born participants (prevalence ratio = 1.81, 95%CI: 1.52, 2.16).

Conclusions: Immigrant status has a strong, negative, direct effect on HL proficiency among racial/ethnic minorities in the USA. This may be a result of barriers that prevent equitable access to resources that improve proper HL proficiency. US policymakers may consider several methods to reduce this disparity at the health-system-, provider-, and patient-levels.

Keywords: health literacy; health policy; immigrant; racial/ethnic minority.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cross-Sectional Studies
Emigrants and Immigrants*
Ethnic and Racial Minorities
Ethnicity
Health Literacy*
Health Status Disparities
Humans
Minority Groups
United States / epidemiology