Exploring health inequalities arising from language proficiency
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Authors
Mai Stafford
Sarah Yeoh
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Issue Date
06-May-26
Type
Conference Abstract
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Keywords
Inequalities
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Abstract
Background and objectives: Over a million people in the UK have low English language proficiency. Qualitative studies show lower access to healthcare and poorer health for people with low English proficiency compared to those with higher proficiency. This study uses routine NHS records to quantify inequalities by language proficiency. It is set in Brent, a London borough where one-third of residents speak a language other than English as their main language.
Methods: Discover-NOW is a linked data resource containing deidentified records from general practices (GP), hospitals and community care settings across northwest London. Based on GP records of needing a translator, difficulty reading or speaking English, adults were categorised as “Not Proficient” (subdivided into Currently / More than 4 years ago) or “Proficient” (subdivided into Main language English/ Main language Other / Main language unknown). A sixth group was categorised as “Not Proficient” with main language English.
Results: “Not Proficient” groups were older and contained more women than “Proficient” groups. In age-sex-adjusted analysis, people “Proficient” with main language English had a higher prevalence of mental health-related conditions, respiratory conditions and cancer compared with most other groups. Those “Not Proficient” currently had higher prevalence of cardiometabolic conditions and higher healthcare use. Those “Not Proficient” with main language English had the highest prevalence of serious mental illness, dementia and learning disability. They were 60% more likely to have multiple hospital admissions and multiple A&E attendances compared with the Proficient with main language English group.
Discussion/learning: Findings suggest that more support with language/understanding in healthcare settings for people who have English as a main language but are not proficient, and for their carers, could be needed. For people who are not proficient in English, more signposting, provision, and training in interpreter services, particularly for cardiometabolic conditions, could be considered. We are at the early stages of working with public health practitioners to draw out implications for Brent.
The analysis also raises questions about the quality of language proficiency data for some people, so we need to explore whether improvements to the data could enhance the interpreter and translation support offered to these patients.