Language-Based Disparities In Children’s Healthcare Access and Quality: Evidence from the 2022 National Survey of Children’s Health

Background and Purpose: Nearly 23% of children in the United States live in households where English is not the primary language, raising concerns about inequitable access to healthcare for linguistically diverse populations. Prior research highlights the importance of effective patient–provider communication in determining care quality; however, population-level disparities by home language remain insufficiently understood. This study examines whether primary household language is associated with differences in children’s access to and quality of healthcare.

Methods: Data were used from the 2022 National Survey of Children’s Health (N = 54,103), a nationally representative survey of U.S. children. Children were categorized by primary household language (“English,” “Spanish,” or “Other”). Outcomes included access to a primary care provider, receipt of care coordination/support, and family-centered care, based on validated parent-report measures. Multivariate logistic regression models were used to assess associations between household language and healthcare outcomes, controlling for key sociodemographic and health-related covariates, including child age, insurance status, and household characteristics.

Results: Children in Spanish-speaking households had significantly lower odds of accessing quality healthcare across all outcomes compared to those in English-speaking households. Specifically, children in Spanish-speaking households had lower odds of having a primary care provider (OR = 0.60, 95% CI: 0.44, 0.59), receiving care coordination/support (OR = 0.38, 95% CI: 0.33, 0.44), and receiving high-quality family-centered care (OR = 0.51, 95% CI: 0.44, 0.59). These findings demonstrate consistent and substantial disparities in both access to and quality of care associated with household language.

Conclusions and Implications: Children in Spanish-speaking households experience significant disparities in healthcare access and quality, likely reflecting structural barriers related to language access, healthcare navigation, and the availability of culturally and linguistically appropriate services. These findings underscore the need for policy and systems-level interventions to expand interpreter and translation services, strengthen implementation of language-access provisions under the Affordable Care Act, and improve accountability for equitable care delivery. Social workers play a critical role in advocating for language access, supporting families in navigating healthcare systems, and advancing policies and practices that promote health equity for linguistically diverse children and families.