语言障碍、医患语言一致性与加利福尼亚北部糖尿病参保者的血糖控制：糖尿病研究（DISTANCE）。

Language barriers, physician-patient language concordance, and glycemic control among insured Latinos with diabetes: the Diabetes Study of Northern California (DISTANCE).

机构信息

Department of Medicine, University of California, San Francisco, CA, USA.

出版信息

J Gen Intern Med. 2011 Feb;26(2):170-6. doi: 10.1007/s11606-010-1507-6. Epub 2010 Sep 29.

DOI:10.1007/s11606-010-1507-6

PMID:20878497

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3019330/

Abstract

BACKGROUND

A significant proportion of US Latinos with diabetes have limited English proficiency (LEP). Whether language barriers in health care contribute to poor glycemic control is unknown.

OBJECTIVE

To assess the association between limited English proficiency (LEP) and glycemic control and whether this association is modified by having a language-concordant physician.

DESIGN

Cross-sectional, observational study using data from the 2005-2006 Diabetes Study of Northern California (DISTANCE). Patients received care in a managed care setting with interpreter services and self-reported their English language ability and the Spanish language ability of their physician. Outcome was poor glycemic control (glycosylated hemoglobin A1c > 9%).

KEY RESULTS

The unadjusted percentage of patients with poor glycemic control was similar among Latino patients with LEP (n = 510) and Latino English-speakers (n = 2,683), and higher in both groups than in whites (n = 3,545) (21% vs 18% vs. 10%, p < 0.005). This relationship differed significantly by patient-provider language concordance (p < 0.01 for interaction). LEP patients with language-discordant physicians (n = 115) were more likely than LEP patients with language-concordant physicians (n = 137) to have poor glycemic control (27.8% vs 16.1% p = 0.02). After controlling for potential demographic and clinical confounders, LEP Latinos with language-concordant physicians had similar odds of poor glycemic control as Latino English speakers (OR 0.89; CI 0.53-1.49), whereas LEP Latinos with language-discordant physicians had greater odds of poor control than Latino English speakers (OR 1.76; CI 1.04-2.97). Among LEP Latinos, having a language discordant physician was associated with significantly poorer glycemic control (OR 1.98; CI 1.03-3.80).

CONCLUSIONS

Language barriers contribute to health disparities among Latinos with diabetes. Limited English proficiency is an independent predictor for poor glycemic control among insured US Latinos with diabetes, an association not observed when care is provided by language-concordant physicians. Future research should determine if strategies to increase language-concordant care improve glycemic control among US Latinos with LEP.

摘要

背景

美国相当一部分西班牙语裔糖尿病患者英语水平有限。医疗保健中的语言障碍是否会导致血糖控制不佳尚不清楚。

目的

评估英语水平有限（LEP）与血糖控制之间的关系，以及这种关系是否因与讲同一种语言的医生有关而有所改变。

设计

使用来自 2005-2006 年北加州糖尿病研究（DISTANCE）的数据进行横断面、观察性研究。患者在管理式医疗环境中接受护理，并提供翻译服务，并自行报告其英语能力和医生的西班牙语能力。结果是血糖控制不佳（糖化血红蛋白 A1c>9%）。

主要结果

在英语水平有限的西班牙语裔患者（n=510）和讲英语的西班牙语裔患者（n=2683）中，血糖控制不佳的患者比例与白人患者（n=3545）相似（21%比 18%比 10%，p<0.005）。这种关系因患者与医生的语言一致性而显著不同（交互作用 p<0.01）。与讲同一种语言的医生（n=137）相比，语言不一致的医生（n=115）的英语水平有限的患者更有可能血糖控制不佳（27.8%比 16.1%，p=0.02）。在控制潜在的人口统计学和临床混杂因素后，与讲同一种语言的医生相比，讲同一种语言的西班牙语裔 LEP 患者血糖控制不佳的可能性相似（OR 0.89；CI 0.53-1.49），而与讲英语的西班牙语裔患者相比，语言不一致的西班牙语裔 LEP 患者血糖控制不佳的可能性更大（OR 1.76；CI 1.04-2.97）。在 LEP 西班牙语裔患者中，语言不一致与血糖控制明显较差有关（OR 1.98；CI 1.03-3.80）。