Language Barriers Tied to Health Disparities in CVD Self-Reporting

Limited English proficiency is linked with a lower rate of patient-reported cardiovascular disease, health disparities that researchers said in JAMA Network Open is either due to low patient education about their CVD or undiagnosed CVD.

Particularly, 79 percent of individuals with limited English proficiency experiencing angina did not disclose a history of CVD; that compares to only 61 percent of patients who do speak English who did not disclose a history of CVD.

These findings come as healthcare professionals work to understand health disparities and how to drive equitable outcomes across different demographics, including individuals who do not speak English as their primary language. Limited English proficiency is tied to a number of care access barriers, and this latest study indicates it may also be linked to underdiagnosis or poor patient education about a current disease state.

The researchers looked at survey data from between 2007 to 2016 that asked participants about any anginal symptoms as well as about their history of cardiovascular disease. Of the more than 19,000 respondents, only 3 percent reported anginal symptoms. Most of those patients spoke English primarily and about 63 percent reported no history of CVD.

To be clear, the researchers asserted this is a problem across all language preferences.

“This presents a major gap in care; many people have symptoms indicative of CVD but have not received a diagnosis,” the research team wrote. “Accordingly, significant improvements are needed in screening and evaluation for CVD in the general US population.”

However, when looking at self-reported demographics, like language preference, the researchers observed some health disparities. Although more than half of all angina patients weren’t reporting any history of CVD, this trend was more common among individuals with limited English proficiency.

Overall, 79 percent of folks with limited English proficiency—defined as accessing the survey in another language besides English—presenting with angina symptoms did not disclose a history of CVD. Said otherwise, only 21 percent of individuals with limited English proficiency and experiencing angina also knew they had a history of cardiovascular problems.

Individuals who primarily speak English were more likely to report that they have CVD history. Overall, only 61 percent of English-speaking angina patients did not report CVD history; that means 39 percent knew to report a history of cardiovascular problems.

This health disparity likely indicates a patient education barrier and underdiagnosing problem, the researchers posited.

“Language discordance between practitioner and patient, inadequate use of interpreters, or other sociocultural barriers may lead to lower rates of appreciation of the presence of anginal symptoms and/or a higher rate of disregarding such symptoms or other disruptions to initiating or completing diagnostic activities,” they wrote in the study.

Additionally, the researchers hypothesized that individuals with limited English proficiency may be more likely to not access healthcare in the first place. Folks who do not primarily speak English may face care access barriers like affordability, geographic barriers, and other social determinants of health keeping them from getting the care they need.

Notably, healthcare has protections in place that should make it easier for individuals with limited English proficiency to still be able to engage with their care, the researchers pointed out.

“Federal regulations, such as Title VI of the Civil Rights Act, are in place to protect individuals with LEP from discrimination and receipt of substandard health care,” they wrote. “However, data indicate that some hospitals do not provide sufficient language services to patients with LEP and are thereby not compliant with federal law.”

Adhering to those regulations would be a key place to start to improve patient education about key medical histories, like CVD, the researchers suggested. But moving beyond that, individual healthcare organizations and the industry at large should consider how to ameliorate barriers to care that keep individuals from getting a CVD diagnosis in the first place.

“Health care institutions should identify systems-level barriers to care for patients who do not communicate in the dominant language,” the research team concluded. “By incorporating patient-centered practices, such as screening for and assessing risk for CVD in an individual’s preferred language, more patients may benefit from the equitable provision of guideline-directed therapies.”