Disparities in self-management outcomes by limited English proficiency among adults with heart disease.
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ABSTRACT:
SUBMITTER: Nguyen P
PROVIDER: S-EPMC8178122 | biostudies-literature | 2021 Sep
REPOSITORIES: biostudies-literature
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Disparities in self-management outcomes by limited English proficiency among adults with heart disease.
Nguyen Phuong P Schiaffino Melody K MK Lipton Brandy J BJ
Preventive medicine reports 20210518
There are significant disparities in cardiovascular health outcomes by limited English proficiency (LEP). Self-management plans (SMPs) are associated with better patient outcomes, however little is known about the association of LEP with having an SMP among adults with heart disease. This study examined this association using 2013-2016 California Health Interview Survey data. Among adults that received an SMP, we also examined whether they had a hard copy SMP (print or electronic vs. none), and ...[more]
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Project description:BackgroundLimited English proficiency (LEP) is associated with poor health status and worse outcomes.ObjectiveTo examine disparities in hypertension between National Health and Nutrition Examination Survey (NHANES) respondents with LEP versus adequate English proficiency.DesignRetrospective analysis of multi-year survey data.ParticipantsAdults 18 years of age and older who participated in the NHANES survey during the period 2003-2012.Main measuresWe defined participants with LEP as anyone who completed the NHANES survey in a language other than English or with the support of an interpreter. Using logistic regression, we estimated the odds ratio for undiagnosed or uncontrolled hypertension (systolic blood pressure (SBP) > 140 mmHg or diastolic blood pressure (DBP) > 90 mmHg) among LEP participants relative to those with adequate English proficiency. We adjusted for sociodemographic, acculturation-related, and hypertension-related variables.Key resultsFourteen percent (n = 3,269) of the participants had limited English proficiency: 12.4% (n = 2906) used a Spanish questionnaire and 1.6% (n = 363) used an interpreter to complete the survey in another language. Those with LEP had higher odds of elevated blood pressure on physical examination (adjusted odds ratio [AOR] = 1.47 [1.07-2.03]). This finding persisted among participants using an interpreter (AOR = 1.88 [1.15-3.06]) but not among those using the Spanish questionnaire (AOR = 1.32 [0.98-1.80]). In a subgroup analysis, we found that the majority of uncontrolled hypertension was concentrated among individuals with a known diagnosis of hypertension (AOR = 1.80 [1.16-2.81]) rather than those with undiagnosed hypertension (AOR = 1.14 [0.74-1.75]). Interpreter use was associated with increased odds of uncontrolled hypertension, especially among patients who were not being medically managed for hypertension (AOR = 6.56 [1.30-33.12]).ConclusionsIn a nationally representative sample, participants with LEP were more likely to have poorly controlled hypertension than those with adequate English proficiency. LEP is an important driver of disparities in hypertension management and outcomes.
| S-EPMC5442015 | biostudies-literature
Project description:ImportanceIndividuals with limited English proficiency (LEP) may be unaware of underlying cardiovascular disease (CVD) owing to a lack of diagnostic testing or poor communication with health care practitioners.ObjectiveTo evaluate whether participants with anginal symptoms and LEP would be less likely to report a history of CVD compared with those without LEP.Design, study, and participantsThis population-based cross-sectional study combined data from 5 National Health and Nutrition Examination Survey (NHANES) cycles conducted from 2007 to 2016. Each cycle includes an interview that collects demographic, dietary, and health-related data as well as a medical examination component in which physiological measurements are taken. All NHANES participants aged 40 years or older who took the Rose questionnaire were included. Data were analyzed from September 2020 to April 2021.ExposuresLEP was defined as a participant receiving the survey in a non-English language or by interpreter.Main outcomes and measuresThe 7-item Rose questionnaire assessed the presence of anginal symptoms. Self-reported CVD was defined as history of heart failure, coronary heart disease, angina pectoris, or myocardial infarction. The association between LEP status and self-reported CVD among those with anginal symptoms was determined in multivariable-adjusted models. All analyses were weighted per NHANES analytic protocols.ResultsAmong 19 320 participants (mean [SD] age, 57.8 [11.8] years; 9344 [47.2%] male; 4145 [10.6%] Black; 2743 [6.3%] Mexican American; 2111 [4.6%] other Hispanic; 8386 [71.6%] White; and 1935 [6.9%] other race), 583 (3.0%) reported anginal symptoms. Of these, most were non-LEP (484 [96.1%]), women (344 [62.1%]), White (251 [66.8%]), and did not report having CVD (347 [62.8%]). Among those with angina, 73 of 99 respondents with LEP (79.0%) reported not having a history of CVD, compared with 274 of 484 without LEP (61.4%; P = .002). Participants with LEP had 2.8-fold higher odds of not reporting a history of CVD compared with participants without LEP (odds ratio, 2.77; 95% CI, 1.38-5.55; P = .005).Conclusions and relevanceAmong NHANES participants reporting anginal symptoms, participants with LEP were more likely not to report having CVD. This discrepancy may be because of higher rates of undiagnosed CVD or lower awareness of such diagnoses among individuals with LEP. Our findings highlight the relevance of communication strategies for individuals with LEP to provide effective intervention and treatment for CVD prevention.
| S-EPMC8672228 | biostudies-literature
Project description:BackgroundPeople with limited English proficiency (LEP) face greater barriers to accessing medical care than those who are English proficient (EP). Language-related differences in the use of outpatient care across the full spectrum of physician specialties have not been studied.ObjectiveTo compare outpatient visit rates to physicians in 28 specialties by people with LEP vs EP.DesignMultivariable negative binomial regression analysis of nationally representative data from the Medical Expenditure Panel Survey (pooled 2013-2018) with adjustment for age, sex, and self-reported health status.Participants149,611 survey respondents aged 18 and older.ExposureLEP, defined as taking the survey in a language other than English.Main measuresAnnual per capita adjusted visit rate ratios (ARRs) comparing visit rates by LEP and EP persons to individual specialties, and to three categories of specialties: (1) primary care (internal or family medicine, geriatrics, general practice, or obstetrics/gynecology), (2) medical-subspecialties, or (3) surgical specialties.Key resultsPatients with LEP were underrepresented in 26 of 28 specialties. Disparities were particularly large for the following: pulmonology (ARR, 0.26; 95% CI, 0.20-0.35), orthopedics (ARR, 0.35; 95% CI, 0.30-0.40), otolaryngology (ARR, 0.40; 95% CI, 0.27-0.59), and psychiatry (ARR, 0.43; 95% CI, 0.32-0.58). Among individuals with several specific common chronic conditions, LEP-EP disparities in visits to specialties in those conditions generally persisted. Disparities were larger for medical subspecialties (ARR, 0.41; 95% CI, 0.36-0.46) and surgical specialties (ARR, 0.46; 95% CI, 0.42-0.50) than for primary care (ARR, 0.76; 95% CI, 0.72 to 0.79).ConclusionsPatients with LEP are underrepresented in most outpatient specialty practices, particularly medical subspecialties and surgical specialties. Our findings highlight the need to remove language barriers to physician services in order to ensure access to the full spectrum of outpatient specialty care for people with LEP.
| S-EPMC9708984 | biostudies-literature
Project description:BackgroundThere are approximately 25.6 million individuals with limited English proficiency (LEP) in the USA, and this number is increasing.ObjectiveInvestigate associations between LEP and access to care in adults.DesignCross-sectional nationally representative survey.ParticipantsAdults with (n = 18,908) and without (n = 98,060) LEP aged ≥ 18 years identified from the 2014-2018 Medical Expenditure Panel Survey MAIN MEASURES: Associations between LEP and access to healthcare and preventive services were evaluated with multivariable logistic regression models, stratified by age group (18-64 and ≥ 65 years). The official government definition of LEP (answers "not at all/not well/well" to the question "How well do you speak English?") was used. Access to care included having a usual source of care (and if so, distance from usual source of care, difficulty contacting usual source of care, and provision of extended hours), visiting a medical provider in the past 12 months, having to forego or delay care, and having trouble paying for medical bills. Preventive services included blood pressure and cholesterol check, flu vaccination, and cancer screening.Key resultsAdults aged 18-64 years with LEP were significantly more likely to lack a usual source of care (adjusted odds ratios [aOR] = 2.48; 95% confidence interval [CI] = 2.27-2.70), not have visited a medical provider (aOR = 2.02; CI = 1.89-2.16), and to be overdue for receipt of preventive services, including blood pressure check (aOR = 2.00; CI = 1.79-2.23), cholesterol check (aOR = 1.22; CI = 1.03-1.44), and colorectal cancer screening (aOR = 1.58; CI = 1.37-1.83) than adults without LEP. Results were similar among adults aged ≥ 65 years.ConclusionsAdults with LEP had consistently worse access to care than adults without LEP. System-level interventions, such as expanding access to health insurance coverage, providing language services, improving provider training in cultural competence, and increasing diversity in the medical workforce may minimize barriers and improve equity in access to care.
| S-EPMC9971409 | biostudies-literature
Project description:•The role of patient language in pain management and treatment is understudied.•There are disparities in access to pain relievers among people with Limited English Proficiency (LEP).•We need to address the need of people with LEP to reach the objectives of Healthy People 2030.
| S-EPMC10374957 | biostudies-literature
Project description:ObjectiveLimited English proficiency (LEP) has become increasingly recognized as an independent predictor of adverse health outcomes in the United States. We aim to examine trends and summarize current insights into LEP-related disparities in adult otolaryngology.Data sourcesWeb of Science, PubMed, and Scopus.MethodsA systematic review of US-based, peer-reviewed literature evaluating outcomes in adult otolaryngology across primary language or varying levels of English proficiency; results were analyzed for study design, subspecialty, cohort demographics, and outcomes; findings were further assessed with the Kilbourne conceptual framework for health care disparities.ResultsAn initial search yielded 3886 articles. After removal of duplicates, 2906 articles were screened and 31 studies were included after full-text analysis. Head and Neck Oncology (25.8%) and Otology (16.1%) were the most highly represented subspecialty topics. Patients with LEP represented an average of 21.71% (Range 2.21% - 51%) of the study populations. Definitions of LEP were variable. Furthermore, studies specifying patient-reported LEP status reported significant findings more often than those using electronic health record-derived data (p < 0.01). Under the Kilbourne framework, all studies were "detecting" (N = 21, 67.7%) and "understanding" (N = 10, 32.3%) disparities. In outcomes-focused studies, patients with LEP presented with a higher burden of oncologic disease, more severe hearing loss, and disparities in treatment access/implementation.ConclusionPatients with LEP are adversely impacted across various otolaryngology subspecialties. Defining these inequities is vital to provide more targeted and comprehensive care for patients with LEP.Level of evidenceNA Laryngoscope, 135:1248-1258, 2025.
| S-EPMC11903906 | biostudies-literature
Project description:IntroductionIndividuals with limited English proficiency (LEP) face structural challenges to communication in English-speaking healthcare environments. We performed a systematic review to characterize the relationship between LEP and outcomes in stroke prevention, management, and recovery.MethodsA systematic review was conducted using the PubMed, Embase, Scopus, and Web of Science databases. Titles and abstracts from articles identified were read and selected for full text review. Studies meeting inclusion criteria were reviewed in full for study design, aim, and outcomes.ResultsOf 891 unique articles, 20 were included. Eleven articles did not provide information about interpreter availability or usage, limiting the ability to draw conclusions about the effect of LEP on measured outcomes in these studies. Overall, studies demonstrated that English proficiency is associated with better outcomes in preventive aspects of stroke care such as stroke symptom awareness, anticoagulation maintenance, and knowledge of warfarin indication. Some acute stroke care metrics were independent of English proficiency in seven studies while other evidence showed associations between interpreter requirement and quality of inpatient care received. LEP and English-proficient groups show similar mortality despite greater lengths of stay and greater proportions of care in dedicated stroke units for LEP patients. Post-stroke quality of life can be worse for those with LEP, and language barriers can negatively impact patient and provider experiences of rehabilitation.ConclusionsStroke patients with LEP face barriers to equitable care at multiple stages. While some studies demonstrate worse outcomes for LEP patients, equitable care was shown in multiple studies frequently in the setting of a high degree of interpreter availability. Patients with LEP will benefit from tailored education regarding stroke symptom recognition and medication regimens, and from provision of translated written educational material. Inequities in inpatient care and rehabilitation exist despite similar mortality rates in four studies. Future studies should report interpreter availability and usage within LEP groups and whether patient interactions were language-concordant or discordant in order to allow for more generalizable and reliable conclusions.
| S-EPMC8850381 | biostudies-literature
Project description:ObjectivesTo conduct comparative cost analysis of hospital care for critically ill patients with Limited English Proficiency (LEP) versus patients with English proficiency (controls).Patients and methodsWe conducted a historical cohort study using propensity matching at Mayo Clinic Rochester, a quaternary care academic center. We included hospitalized patients who had at least one admission to ICU during a 10-year period between 1/1/2008-12/31/2017.ResultsDue to substantial differences in baseline characteristics of the groups, propensity matching for the covariates age, sex, race, ethnicity, APACHE 3 score, and Charlson Comorbidity score was used, and we achieved the intended balance. The final cohort included 80,404 patients, 4,246 with LEP and 76,158 controls. Patients with LEP had higher costs during hospital admission to discharge, with a mean cost difference of $3861 (95% CI $822 to $6900, p = 0.013) and also higher costs during index ICU admission to hospital discharge, with a mean cost difference of $3166 (95% CI $231 to $6101, p = 0.035). A propensity matched cohort including only those that survived showed those with LEP had significantly greater mean costs for all outcomes. Sensitivity analysis revealed that international patients with LEP had significantly greater overall hospital costs of $9,240 than patients with LEP who resided in the US (95% CI $3341 to $15,140, p = 0.002).ConclusionThis is the first study to demonstrate significantly higher costs for patients with LEP experiencing a critical illness. The causes for this may be increased healthcare utilization secondary to communication deficiencies that impede timely decision making about care.
| S-EPMC10132690 | biostudies-literature
Project description:Background and objectivesThis study examined the effect of limited English proficiency (LEP) on trajectories of depressive symptoms among Mexican American older adults in the United States.Research design and methodsThe sample was drawn from Waves 1 to 6 (1993-2007) of the Hispanic Established Population for Epidemiological Studies of the Elderly (H-EPESE). A total of 2,945 Mexican American older adults were included in the analyses. A latent growth curve modeling was conducted.ResultsAfter adjusting for covariates, results show that Mexican American older adults with LEP had higher levels of depressive symptoms than those with English proficiency (EP) at baseline as well as over a 14-year period. Differential trajectories were observed between those with LEP and EP over time, indicating that those with LEP had a significantly steeper curve of depressive symptom trajectories over time than those with EP.Discussion and implicationsThese results suggest that LEP is a risk factor not merely for greater depressive symptomatology at each time point, but for an accelerated trajectory of depressive symptoms over time among Mexican American older adults. Overall, the findings emphasize the need to assist not only the informal support system of Mexican American older adults with LEP, but also the formal system.
| S-EPMC6857694 | biostudies-literature
Project description:BackgroundLimited English proficiency (LEP) is common among hospitalized patients and may impact care. We synthesized the literature comparing clinical outcomes after in-hospital care for English-proficient(EP) versus LEP patients.MethodsThis systematic review searched PubMed, Embase, and Web of Science from database inception through June 7, 2020, to identify research investigating clinical outcomes in patients receiving hospital-based care (in the emergency department, inpatient ward, surgical/procedural suite, or intensive care unit) that compared patients with LEP to an EP group. We assessed mortality, length of stay (LOS), readmissions/revisits, and complications. Study quality was evaluated using the Newcastle-Ottawa Scale.ResultsTwenty-six studies met eligibility criteria. Study settings and populations were heterogeneous. Determination of primary language varied; a majority of studies (16/26) used patient self-report directly or via hospital records. Of 16 studies examining LEP and all-cause mortality, 13 found no significant association. Of 17 studies measuring LOS, 9 found no difference, 4 found longer LOS, 3 found shorter LOS, and 1 had mixed LOS results among patients with LEP. Several investigations suggested that LOS differences may be mediated at the hospital level. Nine studies evaluated inpatient readmissions. Among patients with LEP, there was evidence for increased readmissions in the setting of chronic medical conditions such as heart failure, but no evidence for increased readmissions among cohorts undergoing surgeries/procedures or with acute medical conditions. Five studies evaluated complications or harm related to a hospitalization, and no differences were found between language groups.DiscussionThe research community lacks a standardized definition of LEP. Most studies did not find an association between English proficiency and mortality or complications. LOS findings were mixed and may be influenced at the hospital level. Differences in readmissions by language were concentrated in chronic medical conditions. Given the paucity of studies examining LEP populations, additional research is imperative.Prospero registration numberCRD42020143477.
| S-EPMC9198156 | biostudies-literature