(19.08) Impact of Limited English Proficiency on Vitamin D Intake among US Women with Low Bone Mineral Density

Inadequate dietary intake of vitamin D (Vit D) contributes to decreased bone mineral density (BMD) and increases risk of osteoporosis. Approximately 1 in 5 adults in the US speak a primary language other than English, and a large proportion of these individuals have limited English proficiency (LEP), who disproportionately experience disparities in preventative healthcare. However, little is known about the independent association of LEP with Vit D intake in US women with low BMD.

Methods:

We used data from the National Health and Nutrition Examination Survey (NHANES) for the years 2009-10, 2013–14 and 2017–18 to estimate the association between LEP and Vit D intake among US women ≥ 50 years with low BMD, defined as femur neck T-score that is ≤ - 1. Osteoporosis was defined by a T-score ≤ -2.5. BMD assessment in NHANES was not completed in 2011–12 and 2015–2016, and therefore not included in the analysis. LEP was defined as taking the interview instrument in a language other than English or the use of an interpreter during the interview. Participants with missing BMD data were excluded. Descriptive analyses were conducted to assess the characteristics of the study sample, divided based on English Proficiency. Multivariate Logistic regression was used to estimate the association between LEP and Vit D intake. To adjust for the combination of 3 NHANES cycles, we divided each participant’s weight by a factor of 3, per NHANES analytics protocol.

Results:

A total of 26,601,331 women aged ≥ 50 years with low BMD were included in the analysis (mean age ± SD: 65.1 ± 9.3; mean T-score ± S.D: -1.89 ± 0.63). Median daily Vit D intake was 800 IU (IQR: 284 -1709.3 IU). Only 50.2% of the cohort had daily Vit D intake ≥ 800 IU.
6.4% of the cohort had LEP and were predominantly Hispanic (62.7%) and Others – Asian/Mixed race (32.6%). In LEP women, prevalence of osteoporosis was significantly higher (15.2% vs 21.5%, p=0.001) and median [IQR] Vit D intake was significantly lower (850 [300-1760] IU vs. 356 [120-800] IU, p=0.001).
Inadequate Vit-D intake (< 800 IU/day) was disproportionately greater in women with LEP (48.1% vs 74.1%, p=0.001). On multivariate analysis controlling for potential socio-demographic variables (age, race-ethnicity, education, poverty, health insurance), LEP was independently associated with inadequate Vit D intake (aOR [95% CI]: 1.194 [1.188-1.200], p=0.001).

Discussion/Conclusion:

As shown in our analysis, nearly 50% of US women with low BMD had an inadequate Vit D intake. As expected, LEP was highly prevalent in racial-ethnic minorities and was also associated with a greater burden of osteoporosis. Vit D intake was significantly lower in LEP women. LEP was independently associated with inadequate Vit D intake in women with low BMD, putting them at increased risk of progressive bone loss and risk of osteoporosis related complications. Communication gaps due to language barriers can limit patients from actively engaging in preventative lifestyle behaviors and pharmacologic therapies. These findings provide a critical opportunity to enhance efficiency and quality of care for vulnerable patients with LEP.