Muir Ryan T, Kapoor Arunima, Cayley Megan L, Sicard Michelle N, Lien Karen, Southwell Alisia, Dowlatshahi Dar, Sahlas Demetrios J, Saposnik Gustavo, Mandzia Jennifer, Casaubon Leanne K, Hassan Ayman, Perez Yael, Selchen Daniel, Murray Brian J, Lanctot Krista, Kapral Moira K, Herrmann Nathan, Strother Stephen, Yu Amy Y X, Austin Peter C, Bronskill Susan E, Swartz Richard H
University of Toronto, Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Ottawa Stroke Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Cereb Circ Cogn Behav. 2023 Feb 24;4:100163. doi: 10.1016/j.cccb.2023.100163. eCollection 2023.
Differences in ischemic stroke outcomes occur in those with limited English proficiency. These health disparities might arise when a patient's spoken language is discordant from the primary language utilized by the health system. Language concordance is an understudied concept. We examined whether language concordance is associated with differences in vascular risk or post-stroke functional outcomes, depression, obstructive sleep apnea and cognitive impairment.
This was a multi-center observational cross-sectional cohort study. Patients with ischemic stroke/transient ischemic attack (TIA) were consecutively recruited across eight regional stroke centers in Ontario, Canada (2012 - 2018). Participants were language concordant (LC) if they spoke English as their native language, ESL if they used English as a second language, or language discordant (LD) if non-English speaking and requiring translation.
8156 screened patients. 6,556 met inclusion criteria: 5067 LC, 1207 ESL and 282 LD. Compared to LC patients: (i) ESL had increased odds of diabetes (OR = 1.28, = 0.002), dyslipidemia (OR = 1.20, = 0.007), and hypertension (OR = 1.37, <0.001) (ii) LD speaking patients had an increased odds of having dyslipidemia (OR = 1.35, = 0.034), hypertension (OR = 1.37, <0.001), and worse functional outcome (OR = 1.66, <0.0001). ESL (OR = 1.88, <0.0001) and LD (OR = 1.71, <0.0001) patients were more likely to have lower cognitive scores. No associations were noted with obstructive sleep apnea (OSA) or depression.
Measuring language concordance in stroke/TIA reveals differences in neurovascular risk and functional outcome among patients with limited proficiency in the primary language of their health system. Lower cognitive scores must be interpreted with caution as they may be influenced by translation and/or greater vascular risk. Language concordance is a simple, readily available marker to identify those at risk of worse functional outcome. Stroke systems and practitioners must now study why these differences exist and devise adaptive care models, treatments and education strategies to mitigate barriers influenced by language discordance.
英语水平有限的缺血性中风患者的预后存在差异。当患者的口语与医疗系统使用的主要语言不一致时，可能会出现这些健康差异。语言一致性是一个研究较少的概念。我们研究了语言一致性是否与血管风险、中风后功能结局、抑郁、阻塞性睡眠呼吸暂停和认知障碍的差异有关。
这是一项多中心观察性横断面队列研究。在加拿大安大略省的八个地区性中风中心连续招募缺血性中风/短暂性脑缺血发作（TIA）患者（2012 - 2018年）。如果参与者以英语为母语，则为语言一致（LC）；如果他们将英语作为第二语言，则为英语作为第二语言使用者（ESL）；如果是非英语使用者且需要翻译，则为语言不一致（LD）。
8156名患者接受筛查。6556名符合纳入标准：5067名LC，1207名ESL和282名LD。与LC患者相比：（i）ESL患者患糖尿病（OR = 1.28， = 0.002）、血脂异常（OR = 1.20， = 0.007）和高血压（OR = 1.37，<0.001）的几率增加；（ii）LD患者患血脂异常（OR = 1.35， = 0.034）、高血压（OR = 1.37，<0.001）和功能结局较差（OR = 1.66，<0.0001）的几率增加。ESL（OR = 1.88，<0.0001）和LD（OR = 1.71，<0.0001）患者更有可能认知得分较低。未发现与阻塞性睡眠呼吸暂停（OSA）或抑郁有关。
在中风/TIA中测量语言一致性揭示了医疗系统主要语言水平有限的患者在神经血管风险和功能结局方面的差异。较低的认知得分必须谨慎解释，因为它们可能受到翻译和/或更高血管风险的影响。语言一致性是一个简单、易于获得的指标，可用于识别功能结局较差风险的患者。中风系统和从业者现在必须研究这些差异存在的原因，并设计适应性护理模式、治疗方法和教育策略，以减轻受语言不一致影响的障碍。
