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Published on: September 26, 2018
Patient-Physician Language Concordance and Cardiovascular Outcomes Among Patients With Hypertension
Michael Reaume1, Mathieu N Labossière2, Ricardo Batista3,4
1Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Insights
Language-concordant care may reduce major adverse cardiovascular events (MACEs) for hypertension patients. Allophone speakers receiving care in their primary language had 36% fewer MACEs, highlighting disparities in minority language healthcare.
Area of Science:
- Cardiovascular Health
- Health Services Research
- Health Disparities
Background:
- Patients from minority language communities often experience lower quality and safety in healthcare.
- The impact of physician-patient language concordance on health outcomes, particularly for cardiovascular events, remains understudied.
Purpose of the Study:
- To investigate the association between patient-physician language concordance and the risk of major adverse cardiovascular events (MACEs) in adult patients with hypertension.
- To identify potential disparities in healthcare outcomes based on language concordance.
Main Methods:
- Retrospective cohort study using Canadian Community Health Survey data (2003-2014).
- Included adults with self-reported hypertension, excluding Quebec residents.
- Linked survey responses to hospitalization and mortality records; analyzed data from October 2023 to May 2024.
Main Results:
- Among 124,583 patients, 91.7% spoke English, 3.8% French, 0.3% Indigenous languages, and 4.2% allophone languages.
- Few Indigenous language speakers received language-concordant care (<4.6%).
- Allophone speakers receiving language-concordant care had a 36% lower risk of MACEs compared to those receiving discordant care (HR, 0.64; 95% CI, 0.51-0.80). No significant difference was found for French speakers.
Conclusions:
- Significant disparities exist in access to language-concordant care and MACE risk among minority language groups.
- Language-concordant care shows potential to improve health outcomes for individuals in minority language communities, particularly for allophone speakers.
- Further research is needed to address systemic barriers and promote equitable healthcare delivery.
Importance:
Patients who live in minority language communities often receive health care services of lower quality and safety compared with patients who speak the majority language. Yet the outcomes associated with care provided by physicians who speak a patient's primary language remain unknown.
Objective:
To examine patient-physician language concordance and the risk of major adverse cardiovascular events (MACEs) among patients with hypertension.
Design, Setting, And Participants:
This retrospective cohort study identified adults with self-reported hypertension in the Canadian Community Health Survey, a national survey that collects data from a representative sample of Canadians, from January 1, 2003, to December 31, 2014. Respondents (excluding those living in Quebec) had their hospitalization and mortality records linked to their survey responses. Data were analyzed from October 2023 to May 2024.
Exposures:
Respondents' primary home language was defined using language spoken most often at home. Language spoken with a regular physician was used to measure patient-physician language concordance. Respondents who spoke to their regular physician in their primary home language were classified as having received language-concordant care, while all other respondents were classified as having received language-discordant care.
Main Outcomes And Measures:
MACEs within 5 years of survey completion.
Results:
Among the 124 583 patients included in this study, 114 239 (91.7%) spoke English, 4790 (3.8%) spoke French, 325 (0.3%) spoke an Indigenous language, and 5229 (4.2%) spoke an allophone (ie, other) language. The mean (SD) age of the cohort was 63.7 (14.8) years; 57.1% of the patients reported their sex as female. Very few respondents who spoke an Indigenous language at home (<4.6%) received language-concordant care. For French-speaking patients, there was no statistically significant difference in the risk of MACE between those who received language-concordant care and those who received language-discordant care (hazard ratio [HR], 1.09; 95% CI, 0.86-1.36). Allophone-speaking patients who received language-concordant care were 36% less likely to experience MACE (HR, 0.64; 95% CI, 0.51-0.80) compared with allophone-speaking patients who received language-discordant care.
Conclusions And Relevance:
This retrospective cohort study found large disparities in both access to language-concordant care and risk of MACEs. These findings suggest that language-concordant care could potentially improve the health of individuals in minority language communities.
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