Napa-Solano Family Medicine Residency Program, Kaiser Permanente, Vallejo, California.
Division of Research, Kaiser Permanente, Oakland, California.
J Am Geriatr Soc. 2021 Jan;69(1):122-128. doi: 10.1111/jgs.16809. Epub 2020 Sep 10.
BACKGROUND/OBJECTIVES: Hispanics have lower advance directive (AD) completion than non-Hispanic Whites. Few studies have assessed the role of language preference in end-of-life planning. We investigated whether language preference and needing an interpreter affected AD completion among older adults in an integrated health system.
Retrospective cohort investigation of electronic medical records.
Northern California integrated health system.
A total of 620,948 Hispanic and non-Hispanic White patients, aged 55 years and older, between January 1, 2013, and December 31, 2017.
Descriptive statistics and bivariate analysis were performed to compare AD completion among non-Hispanic Whites, Hispanics, and Hispanic subgroups by language preference (English speaking, Spanish speaking, and needed interpreter). We conducted multivariable logistic regression to determine the relationship between language preference and having an AD while controlling for demographic, clinical, and utilization factors.
We found 20.3% of non-Hispanic Whites (n = 512,577) and 10.9% of Hispanics (n = 108,371) had completed an AD. Among Hispanics, after controlling for demographic, clinical, and utilization factors, compared with Spanish speakers requiring an interpreter, English speakers had nearly two-fold increased odds of completing an AD (adjusted odds ratio (aOR) = 2.6; 95% confidence interval (CI) = 2.4-2.9), whereas Spanish speakers not requiring an interpreter had 20% increased odds (aOR = 1.2; 95% CI = 1.1-1.3). Additional predictors of successful AD completion were being female, being older, having more comorbidities, having more hospital and emergency department visits, and having higher socioeconomic status. There were no differences associated with primary care provider characteristics.
These findings indicate the need for a tailored outreach to Hispanics, particularly among those subgroups who require the need of an interpreter, to reduce AD completion disparities.
背景/目的：西班牙裔完成预先指示 (AD) 的比例低于非西班牙裔白人。很少有研究评估语言偏好在生命末期规划中的作用。我们调查了在一个综合医疗系统中，语言偏好和是否需要翻译是否会影响老年人的 AD 完成率。
对电子病历进行回顾性队列研究。
北加州综合医疗系统。
共有 620948 名年龄在 55 岁及以上的西班牙裔和非西班牙裔白人患者，他们在 2013 年 1 月 1 日至 2017 年 12 月 31 日期间接受了治疗。
进行描述性统计和双变量分析，以比较非西班牙裔白人、西班牙裔和西班牙语群体按语言偏好（说英语、说西班牙语和需要翻译）完成 AD 的情况。我们进行多变量逻辑回归，以确定语言偏好与 AD 之间的关系，同时控制人口统计学、临床和利用因素。
我们发现，20.3%的非西班牙裔白人（n=512577）和 10.9%的西班牙裔（n=108371）完成了 AD。在控制了人口统计学、临床和利用因素后，与需要翻译的西班牙语说话者相比，英语说话者完成 AD 的可能性几乎高出两倍（调整后的优势比 (aOR)=2.6；95%置信区间 [CI]：2.4-2.9），而不需要翻译的西班牙语说话者完成 AD 的可能性则增加了 20%（aOR=1.2；95%CI：1.1-1.3）。成功完成 AD 的其他预测因素包括女性、年龄较大、合并症较多、住院和急诊就诊次数较多以及社会经济地位较高。与初级保健提供者的特征没有关联。
这些发现表明，需要针对西班牙裔群体进行有针对性的外展工作，特别是针对那些需要翻译的群体，以减少 AD 完成率的差异。
