Preferred Language Mediates Association Between Race, Ethnicity, and Delayed Presentation in Critically Ill Patients With COVID-19.
Preferred Language Mediates Association Between Race, Ethnicity, and Delayed Presentation in Critically Ill Patients With COVID-19.
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DOI：
10.1097/cce.0000000000000927
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发表时间：
2023-06
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哪些社会因素解释了COVID-19获得护理和结果的种族和民族差异仍不清楚。我们假设，首选语言调解种族，民族和延迟照顾之间的关联。对2020年连续入住马萨诸塞州三家医院ICU的COVID-19成年患者进行的多中心、回顾性队列研究。进行因果中介分析，以评估潜在的调解人，包括首选语言，保险状况，和邻里的特点。非西班牙裔白色（NHW）患者（157/442，36%）更有可能将英语作为首选语言（78%对13%），不太可能没有保险或保险不足（1%对28%），居住在社会脆弱指数（SVI）低于少数族裔患者的社区（SVI百分位数59 [28] vs. 74 [21]），但合并症更多（Charlson合并症指数4.6 [2.5] vs. 3.0 [2.5]），年龄更大（70 [13.2] vs. 58 [15.1]岁）。从症状发作开始，NHW患者比种族和少数民族患者早1.67 [0.71-2.63]天入院（p < 0.01）。非英语首选语言与入院延迟1.29 [0.40-2.18]天相关（p < 0.01）。首选语言在人种、种族和从症状发作到入院的天数之间介导了63%的总效应（p = 0.02）。保险状况、社会脆弱性和到医院的距离不是种族、民族和入院延迟之间的因果关系。首选语言介导了COVID-19重症患者的种族、民族和就诊延迟之间的关联，尽管我们的结果受到可能的碰撞者分层偏倚的限制。有效的COVID-19治疗需要早期诊断，延误会导致死亡率增加。进一步研究偏好语言在种族和民族差异中的作用，可能会找到公平照顾的有效解决方案。
Which social factors explain racial and ethnic disparities in COVID-19 access to care and outcomes remain unclear. We hypothesized that preferred language mediates the association between race, ethnicity and delays to care. Multicenter, retrospective cohort study of adults with COVID-19 consecutively admitted to the ICU in three Massachusetts hospitals in 2020. Causal mediation analysis was performed to evaluate potential mediators including preferred language, insurance status, and neighborhood characteristics. Non-Hispanic White (NHW) patients (157/442, 36%) were more likely to speak English as their preferred language (78% vs. 13%), were less likely to be un- or under-insured (1% vs. 28%), lived in neighborhoods with lower social vulnerability index (SVI) than patients from racial and ethnic minority groups (SVI percentile 59 [28] vs. 74 [21]) but had more comorbidities (Charlson comorbidity index 4.6 [2.5] vs. 3.0 [2.5]), and were older (70 [13.2] vs. 58 [15.1] years). From symptom onset, NHW patients were admitted 1.67 [0.71–2.63] days earlier than patients from racial and ethnic minority groups (p < 0.01). Non-English preferred language was associated with delay to admission of 1.29 [0.40–2.18] days (p < 0.01). Preferred language mediated 63% of the total effect (p = 0.02) between race, ethnicity and days from symptom onset to hospital admission. Insurance status, social vulnerability, and distance to the hospital were not on the causal pathway between race, ethnicity and delay to admission. Preferred language mediates the association between race, ethnicity and delays to presentation for critically ill patients with COVID-19, although our results are limited by possible collider stratification bias. Effective COVID-19 treatments require early diagnosis, and delays are associated with increased mortality. Further research on the role preferred language plays in racial and ethnic disparities may identify effective solutions for equitable care.