We present descriptive statistics on the CCAHS and BRFSS in , first for all respondents and then for the Latino sub-sample from both data sets. The distribution of SRH across response categories is fairly similar in the two data sets, for both the full sample and the Latino sample. For example, the unadjusted odds ratio (not shown) of being in poor or fair health for Latinos compared to whites is 2.95 (p < 0.001) in the CCAHS and 2.24 (p < 0.001) in the BRFSS. Also noteworthy is that the proportion of Latinos who were administered the questionnaire in Spanish was almost identical in the two data sets (0.44 in the CCHAS and 0.43 in the BRFSS). Reflecting particular aspects of Chicago’s population, the CCAHS has a different racial/ethnic distribution than the BRFSS (with higher proportions of Latinos and blacks and a smaller proportion of whites), and CCAHS respondents have lower levels of education than those in the BRFSS, but otherwise, the two data sets are fairly comparable on most variables.
Characteristics (Weighted Proportions (SE)) of Study Participants, CCAHS 2002 and BRFSS 2003
In we present logistic regression models predicting poor/fair SRH. The results from model 1 show that the odds of rating one’s health as poor or fair are 86 percent higher for Latinos compared to whites in the CCAHS and 66 percent higher in the BRFSS, after adjusting for sex, age, education, and income. Model 2 shows that being interviewed in Spanish is associated with significantly higher odds of poor/fair SRH, and that adjusting for language of interview narrows the estimated Latino-white SRH gap considerably, to a point where the coefficients are almost identical in the two data sets (and the CCAHS coefficient is no longer significant). In model 3 we add controls for other health risks/conditions that could confound the association between language of interview and SRH. Interestingly, we find that the Spanish language effect gets larger in both data sets after adjusting for these risk factors, and supplemental analysis found that the main reason for this increase was that Spanish interviewees reported fewer chronic health conditions; thus controlling for those conditions increases their odds of reporting poor/fair SRH. The implications of adding these controls for the Latino-white SRH gap was different in the two data sets: the gap narrowed in model 3 in the CCAHS but increased in the BRFSS.
Odds Ratios and 95% Confidence Intervals of Poor/Fair Self-Rated Health, CCAHS 2002 and BRFSS 2003
The results from generally replicate what has been found in prior studies regarding the role of language of interview in reducing SRH disparities between Latinos and whites. However, most prior studies have stopped here and not investigated whether the translation of the SRH response categories from English to Spanish results in a “heaping” of responses on the “fair” category among Spanish speakers after multiple controls. To test this hypothesis, we turned to multinomial logistic regression models that estimate the log odds of responding “fair” health compared to each of the other categories. presents the relative risk ratios associated with having a Spanish-language interview on the odds of rating one’s health as fair/regular compared to the other options. Only the Spanish-language coefficients are displayed in , but model 1 adjusts for the “core” set of covariates (see , model 2), and model 2 adds controls for the additional health risk factors/conditions (see , model 3). The results show that respondents who interviewed in Spanish were more likely to rate their health as regular than any other category, even after adjusting for the full set of covariates in model 2, and in all but one case (fair vs. poor health in CCAHS, model 2), this association was significant. Also noteworthy in model 2 is that the tendency for Spanish interviewees to rate their health as regular is most pronounced when contrasted to the odds of selecting categories that represent better health (good, very good, or excellent), consistent with the idea that Spanish-language respondents may have better assessments of their health than the English word “fair” implies. In addition, the Latino-white gap in the odds of reporting “fair” health is reduced by controlling for language of interview (results not shown).
Multinomial Logistic Regression Models of Effects of Language of Interview on Response Category of Self-Rated Health Question
Supplemental analysis (not shown) assessed whether the association between being interviewed in Spanish and rating one’s health as regular was confounded by immigrant status or level of linguistic acculturation, measures available in the CCAHS but not in the BRFSS. Controlling for nativity status, age at migration, and the linguistic acculturation scale did not alter our results. We also examined whether the language-of-interview effect on SRH varied by nativity, age at migration, and Latino subgroup by including appropriate interaction terms in our models but found none to be statistically significant.
To help interpret the results from the multinomial models, we used the coefficients from model 1 in to calculate the predicted probability of responding to each SRH category, and graphed these predicted probabilities in , highlighting the comparison between Latinos who responded to the interview in English versus Spanish. The predicted probabilities that Latino-English and Latino-Spanish interviewees will rate their health as “fair” are very comparable across the two data sets: the probability of selecting “fair” for Latino-English interviewees was 0.11 in the CCAHS and 0.14 in the BRFSS, while the probability of selecting “regular” for Latino-Spanish interviewees was 0.24 in the CCAHS and 0.26 in the BRFSS. The predicted probabilities for the other categories did not match as closely across the two data sets, with the main difference being that the Latino-Spanish respondents in the CCAHS were more likely than their counterparts in the BRFSS to rate their health as excellent or very good (compared to good).
Adjusted Predicted Probabilities a of Self-rated Health (SRH) for Latinos by Language of Interview, CCHAS 2002 and BRFSS 2003