ORIGINAL RESEARCH
Hayley B. Gershengorn, MD; Samira Patel, MBA; Andrea Carlotto; Bhavarth Shukla, MD, MPH; Marie Anne Sosa, MD, MBA; Dipen J. Parekh, MD; Tanira Ferreira, MD
Corresponding Author: Hayley B. Gershengorn, MD; University of Miami, Miller School of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine.
Email: hbg20@med.miami.edu
DOI: 10.3122/jabfm.2025.250202R1
Keywords: Access to Care, Communication Barriers, Doctor Patient Relations, Emergency Room Visits, Health Communication, Health Disparities, Health Services, Hispanics, Hospitalization Language, Minority Health, Primary Care Physicians, Primary Health Care, Quality of Care, Retrospective Studies, Workforce
Dates: Submitted: 05-29-2025; Revised: 07-16-2025; Accepted: 09-02-2025
Status: Volume 39, Issue 1 (Publishes March 2026)
BACKGROUND: Patient-clinician language concordance impacts healthcare experiences and outcomes. The association of patient-primary care physician (PCP) language concordance with resource use is understudied.
METHODS: We conducted a retrospective study of adults with a PCP visit from January 2020 – March 2023 at UHealth. Our primary exposure was patient-PCP language concordance. Our primary outcome was emergency department (ED) visit within 1 year after PCP encounter. We used multivariable regression modeling, with sensitivity and exploratory analyses to investigate the interplay of language concordance, preferred language (English/Spanish), and ethnicity.
RESULTS: We included 22,093 patients across 48 PCPs (29 [60.4%] with Spanish language ability). 21,034 (95.2%) were in language concordant patient-PCP dyads and 3,155 (15.0%) preferred Spanish; language concordant patients were less commonly Hispanic (45.8% vs 94.4%, SMD 1.29). Language concordance was associated with lower odds of 1-year ED visit (unadjusted rate: 6.7% vs 9.3%, SMD 0.09, p=0.002; adjusted OR [95% CI]: 0.77 [0.61,0.97]). Sensitivity analyses using a more nuanced exposure (English-English concordance = reference; Spanish-Spanish concordance, OR [95% CI]: 1.43 [1.23,1.66]; discordance, OR [95% CI]: 1.43 [1.13.1.80]) and, separately, restricting the cohort to Spanish-speaking patients (language concordance, OR [95% CI]: 0.99 [0.76,1.29]) as well as an exploratory analysis adding preferred language to the primary model (language concordance, OR [95% CI]: 1.00 [0.78,1.29]) suggested the association of language concordance was fully confounded by preferred language. Ethnicity had less of an effect.
CONCLUSIONS: Patient-PCP language concordance is associated with a reduced odds of 1-year ED visit. But as this association was not observed within the subcohort of only Spanish-speaking patients, it appears to be fully confounded by patient preferred language.