Dataset Information

Disparities in Reporting a History of Cardiovascular Disease Among Adults With Limited English Proficiency and Angina.

ABSTRACT:

Importance

Individuals 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.

Objective

To 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 participants

This 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.

Exposures

LEP was defined as a participant receiving the survey in a non-English language or by interpreter.

Main outcomes and measures

The 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.

Results

Among 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 relevance

Among 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.

SUBMITTER: Herbert BM

PROVIDER: S-EPMC8672228 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:BACKGROUND:Limited English proficiency (LEP) is associated with poor health status and worse outcomes. OBJECTIVE:To examine disparities in hypertension between National Health and Nutrition Examination Survey (NHANES) respondents with LEP versus adequate English proficiency. DESIGN:Retrospective analysis of multi-year survey data. PARTICIPANTS:Adults 18 years of age and older who participated in the NHANES survey during the period 2003-2012. MAIN MEASURES:We 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 RESULTS:Fourteen 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]). CONCLUSIONS:In 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.

Project description:BackgroundPatient awareness of CKD and primary care provider (PCP) recognition of CKD are lower than for other chronic conditions. Understanding how patients may become aware of CKD is critical to their participation in healthy behaviors to slow CKD progression. We examined factors associated with the concordance of CKD awareness among patients and providers and hypothesized that concordance of CKD awareness would be influenced by social and demographic factors that impact communication, such as limited English proficiency (LEP) and health literacy.MethodsBetween July 2011 to July 2014, patients with CKD from three primary care clinics in a public healthcare delivery system were surveyed with questions regarding their health, including awareness of their CKD status. Chart review was performed to identify PCP recognition of CKD, defined as CKD listed anywhere in the problem list within nine months before patient enrollment into the study. We used logistic regression to determine the association between provider recognition and patient awareness of kidney disease among those patients with CKD, adjusting for patient demographics, co-morbidities, and provider training.ResultsThe study population (n = 152) had a mean age of 57.4 (SD 13), was 48.7% male and was racially/ethnically and linguistically diverse: 89.5% self-identified as Black, Hispanic, or Asian and 32.2% had LEP. Most patients had hypertension (89.5%) and diabetes (77.6%); mean eGFR was 66.1 ml/min/1.73m2 (SD 32.8). Positive concordance of CKD awareness was 42% (n = 64). Odds of positive concordance with their providers were much higher among patients with LEP compared to English speaking patients (adjusted odds ratio = 11.07, 95%CI 1.60-76.39).ConclusionsConcordance of CKD awareness among PCPs and their patients with CKD in one public delivery system was higher among patients with LEP. While speculative, this may be due to greater caution in provider communication about CKD with LEP patients.