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Preferred Language Mediates Association Between Race, Ethnicity, and Delayed Presentation in Critically Ill Patients
Michael S Kelly1, Adna Mohammed1, Daniel Okin1,2,3
1Department of Medicine, Massachusetts General Hospital, Boston, MA.
Critical Care Explorations
|June 19, 2023
Summary
Preferred language significantly delays critical COVID-19 care for racial and ethnic minorities. Addressing language barriers is crucial for reducing disparities and improving patient outcomes in emergency care.
Area of Science:
- Health Services Research
- Health Disparities
- Infectious Disease Epidemiology
Background:
- Racial and ethnic disparities in COVID-19 care access and outcomes persist, with underlying social factors remaining unclear.
- Understanding these disparities is critical for developing equitable healthcare strategies during public health crises.
Purpose of the Study:
- To investigate the hypothesis that preferred language acts as a mediator between race/ethnicity and delays in accessing COVID-19 care.
- To identify key social factors contributing to disparities in timely medical attention for COVID-19 patients.
Main Methods:
- A multicenter, retrospective cohort study included adult COVID-19 patients admitted to ICUs across three Massachusetts hospitals in 2020.
- Causal mediation analysis was employed to assess the role of preferred language, insurance status, and neighborhood characteristics as potential mediators.
- The study analyzed the association between race, ethnicity, preferred language, and time from symptom onset to hospital admission.
Main Results:
- Non-Hispanic White patients were more likely to prefer English, have insurance, live in areas with lower social vulnerability, but had more comorbidities and were older.
- Patients preferring non-English languages experienced a significant delay in hospital admission (1.29 days, p < 0.01).
- Preferred language mediated 63% of the effect between race/ethnicity and delays in hospital admission (p = 0.02), while insurance and social vulnerability did not.
Conclusions:
- Preferred language is a significant mediator of racial and ethnic disparities in delays to critical COVID-19 care presentation.
- Early diagnosis is vital for effective COVID-19 treatment, and delays are linked to increased mortality.
- Further research into the impact of preferred language is essential for developing interventions to ensure equitable care.
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