Kelly Michael S, Mohammed Adna, Okin Daniel, Alba George A, Jesudasen Sirus J, Flanagan Shelby, Dandawate Nupur A, Gavralidis Alexander, Chang Leslie L, Moin Emily E, Witkin Alison S, Hibbert Kathryn A, Kadar Aran, Gordan Patrick L, Bebell Lisa M, Hauptman Marissa, Valeri Linda, Lai Peggy S
Department of Medicine, Massachusetts General Hospital, Boston, MA.
Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA.
Crit Care Explor. 2023 Jun 14;5(6):e0927. doi: 10.1097/CCE.0000000000000927. eCollection 2023 Jun.
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 ( < 0.01). Non-English preferred language was associated with delay to admission of 1.29 [0.40-2.18] days ( < 0.01). Preferred language mediated 63% of the total effect ( = 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.
哪些社会因素导致新冠疫情期间在获得医疗服务和治疗结果方面存在种族和族裔差异仍不清楚。
我们假设偏好语言在种族、族裔与就医延迟之间的关联中起中介作用。
设计、背景与参与者：对2020年在马萨诸塞州三家医院重症监护病房连续收治的成年新冠患者进行多中心回顾性队列研究。
进行因果中介分析以评估潜在中介因素，包括偏好语言、保险状况和社区特征。
非西班牙裔白人（NHW）患者（157/442，36%）更有可能将英语作为偏好语言（78%对13%），无保险或保险不足的可能性较小（1%对28%），与少数族裔患者相比，他们居住的社区社会脆弱性指数（SVI）较低（SVI百分位数59[28]对74[21]），但合并症更多（查尔森合并症指数4.6[2.5]对3.0[2.5]），且年龄更大（70[13.2]岁对58[15.1]岁）。从症状出现开始，NHW患者比少数族裔患者提前1.67[0.71 - 2.63]天入院（<0.01）。偏好非英语与入院延迟1.29[0.40 - 2.18]天相关（<0.01）。偏好语言介导了种族、族裔与从症状出现到入院天数之间总效应的63%（=0.02）。保险状况、社会脆弱性和距离医院远近不在种族、族裔与入院延迟之间的因果路径上。
偏好语言在新冠危重症患者的种族、族裔与就诊延迟之间的关联中起中介作用，尽管我们的结果可能受到对撞分层偏差的限制。有效的新冠治疗需要早期诊断，而延迟与死亡率增加相关。对偏好语言在种族和族裔差异中所起作用的进一步研究可能会找到公平医疗的有效解决方案。
