Women's Age Lab and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
Division of General Internal Medicine and Geriatrics, Sinai Health System and the University Health Network, Toronto, Ontario, Canada.
JAMA Netw Open. 2024 Nov 4;7(11):e2448010. doi: 10.1001/jamanetworkopen.2024.48010.
Patients with a non-English language preference served within English-dominant health care settings are at increased risk of adverse events that may be associated with communication barriers and inequitable access to care.
To investigate the association of non-English language preference with surgical wait time and postoperative outcomes in older patients undergoing hip fracture repair.
DESIGN, SETTING, AND PARTICIPANTS: This population-based, retrospective cohort study was conducted using linked databases to measure surgical wait time and postoperative outcomes among older adults (aged ≥66 years) in Ontario, Canada, who underwent hip fracture surgery between January 1, 2017, and December 31, 2022. Propensity-based overlap weighting accounting for baseline patient characteristics was used to compare primary and secondary outcomes.
Non-English language preference.
The primary outcome was surgical delay beyond 24 hours. Secondary outcomes included time to surgery, surgical delay beyond 48 hours, postoperative medical complications, length of stay, discharge destination, 30-day mortality, and 30-day hospital readmission.
Among 35 238 patients who underwent hip fracture surgery, 28 815 individuals (81.8%) were English speakers (mean [SD] age, 84.4 [8.0] years; 19 965 female [69.3%]) and 6423 individuals (18.2%) were non-English speakers (mean [SD] age, 85.5 [7.0] years; 4556 female [70.9%]). The median (IQR) wait time for surgery was similar for English (24 [16-41] hours) and non-English (25 [16-42] hours) speakers. There was no significant difference in surgical delay beyond 24 hours between English-speaking and non-English-speaking patients (3321 patients [51.7%] vs 14 499 patients [50.3%]; adjusted relative risk [aRR], 1.00; 95% CI, 0.98-1.03). Compared with English speakers, patients with a non-English language preference had increased risk of delirium (4207 patients [14.6%] vs 1209 patients [18.8%]; aRR, 1.10; 95% CI, 1.03-1.17), myocardial infarction (150 patients [0.5%] vs 43 patients [0.7%]; aRR, 1.52; 95% CI, 1.04-2.22), longer length of stay (median [IQR], 10 [6-17] vs 11 [7-20] days; aRR per 1-day increase, 1.11; 95% CI, 1.06-1.15), and more frequent discharge to a nursing home (1814 of 26 673 patients surviving to discharge [6.8%] vs 413 of 5903 patients surviving to discharge [7.0%]; aRR, 1.13; 95% CI, 1.01-1.27).
In this study of older adults with hip fracture, non-English language preference was associated with increased risk of delirium, myocardial infarction, longer length of stay, and discharge to a nursing home. These findings suggest inequities in hip fracture care for patients with a non-English language preference.
在以英语为主导的医疗环境中，有非英语语言偏好的患者面临着更多的不良事件风险，这些风险可能与沟通障碍和获得医疗服务的不平等有关。
调查非英语语言偏好与老年髋部骨折修复患者手术等待时间和术后结果之间的关系。
设计、地点和参与者：本研究是一项基于人群的回顾性队列研究，使用关联数据库来衡量加拿大安大略省年龄在 66 岁及以上的成年人在髋部骨折手术后的手术等待时间和术后结果。采用基于倾向的重叠加权法，考虑了基线患者特征，以比较主要和次要结果。
非英语语言偏好。
主要结果是手术延迟超过 24 小时。次要结果包括手术时间、手术延迟超过 48 小时、术后医疗并发症、住院时间、出院目的地、30 天死亡率和 30 天医院再入院率。
在 35238 名接受髋部骨折手术的患者中，28815 名（81.8%）是英语使用者（平均[标准差]年龄为 84.4[8.0]岁；19965 名女性[69.3%]）和 6423 名（18.2%）非英语使用者（平均[标准差]年龄为 85.5[7.0]岁；4556 名女性[70.9%]）。手术等待时间的中位数（IQR）在英语（24[16-41]小时）和非英语（25[16-42]小时）使用者之间相似。英语和非英语使用者之间在 24 小时以上的手术延迟方面没有显著差异（3321 名患者[51.7%]与 14499 名患者[50.3%]；调整后的相对风险[aRR]，1.00；95%CI，0.98-1.03）。与英语使用者相比，非英语语言偏好的患者有更高的谵妄风险（4207 名患者[14.6%]与 1209 名患者[18.8%]；aRR，1.10；95%CI，1.03-1.17）、心肌梗死（150 名患者[0.5%]与 43 名患者[0.7%]；aRR，1.52；95%CI，1.04-2.22）、更长的住院时间（中位数[IQR]，10[6-17]天与 11[7-20]天；aRR 每增加 1 天，1.11；95%CI，1.06-1.15）和更多的患者出院到养老院（26673 名存活至出院的患者中有 1814 名[6.8%]与 5903 名存活至出院的患者中有 413 名[7.0%]；aRR，1.13；95%CI，1.01-1.27）。
在这项对老年髋部骨折患者的研究中，非英语语言偏好与谵妄、心肌梗死、更长的住院时间和出院到养老院的风险增加有关。这些发现表明，非英语语言偏好的患者在髋部骨折护理方面存在不平等现象。
