Language discordance as a marker of disparities in cerebrovascular risk and stroke outcomes: A multi-center Canadian study

Ryan T. Muir; Arunima Kapoor; Megan L. Cayley; Michelle N Sicard; Karen Lien; Alisia Southwell; Dar Dowlatshahi; Demetrios J. Sahlas; Gustavo Saposnik; Jennifer Mandzia; Leanne K. Casaubon; Ayman Hassan; Yael Perez; Daniel Selchen; Brian J. Murray; Krista Lanctot; Moira K. Kapral; Nathan Herrmann; Stephen Strother; Amy．Y．X Yu; Peter C. Austin; Susan E. Bronskill; Richard H. Swartz

Cerebral Circulation - Cognition and Behavior (Jan 2023)

Language discordance as a marker of disparities in cerebrovascular risk and stroke outcomes: A multi-center Canadian study

Ryan T. Muir,
Arunima Kapoor,
Megan L. Cayley,
Michelle N Sicard,
Karen Lien,
Alisia Southwell,
Dar Dowlatshahi,
Demetrios J. Sahlas,
Gustavo Saposnik,
Jennifer Mandzia,
Leanne K. Casaubon,
Ayman Hassan,
Yael Perez,
Daniel Selchen,
Brian J. Murray,
Krista Lanctot,
Moira K. Kapral,
Nathan Herrmann,
Stephen Strother,
Amy．Y．X Yu,
Peter C. Austin,
Susan E. Bronskill,
Richard H. Swartz

Affiliations

Ryan T. Muir: University of Toronto, Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Arunima Kapoor: University of Toronto, Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Megan L. Cayley: University of Toronto, Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Michelle N Sicard: University of Toronto, Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Karen Lien: University of Toronto, Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Alisia Southwell: University of Toronto, Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Dar Dowlatshahi: Ottawa Stroke Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
Demetrios J. Sahlas: McMaster University, Department of Medicine (Neurology), Hamilton General Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
Gustavo Saposnik: St. Michael's Hospital, Division of Neurology, Toronto, ON, Canada
Jennifer Mandzia: London Health Sciences Centre, Division of Neurology, London, ON, Canada
Leanne K. Casaubon: University Health Network/Toronto Western Hospital, Division of Neurology, Toronto, ON, Canada
Ayman Hassan: Thunder Bay Regional Health Sciences Centre, Division of Neurology, Thunder Bay, ON, Canada
Yael Perez: Trillium Health Partners, Department of Medicine (Neurology), Mississauga, ON, Canada
Daniel Selchen: St. Michael's Hospital, Division of Neurology, Toronto, ON, Canada
Brian J. Murray: University of Toronto, Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada
Krista Lanctot: Sunnybrook Research Institute, Toronto, ON, Canada; University of Toronto, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON Canada
Moira K. Kapral: Sunnybrook Research Institute, Toronto, ON, Canada; University of Toronto, Department of Medicine, Division of General Internal Medicine, Toronto, Canada; ICES, Toronto, ON, Canada; University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, ON, Canada
Nathan Herrmann: Sunnybrook Research Institute, Toronto, ON, Canada; University of Toronto, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON Canada
Stephen Strother: Rotman Research Institute, Centre for Stroke Recovery, Baycrest Site, Toronto, ON, Canada
Amy．Y．X Yu: University of Toronto, Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada; ICES, Toronto, ON, Canada; University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, ON, Canada
Peter C. Austin: ICES, Toronto, ON, Canada; University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, ON, Canada
Susan E. Bronskill: Sunnybrook Research Institute, Toronto, ON, Canada; ICES, Toronto, ON, Canada; University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, ON, Canada
Richard H. Swartz: University of Toronto, Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Corresponding author.

Journal volume & issue: Vol. 4
p. 100163

Abstract

Read online

Background: 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. Methods: 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. Results: 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, p = 0.002), dyslipidemia (OR = 1.20, p = 0.007), and hypertension (OR = 1.37, p<0.001) (ii) LD speaking patients had an increased odds of having dyslipidemia (OR = 1.35, p = 0.034), hypertension (OR = 1.37, p<0.001), and worse functional outcome (OR = 1.66, p<0.0001). ESL (OR = 1.88, p<0.0001) and LD (OR = 1.71, p<0.0001) patients were more likely to have lower cognitive scores. No associations were noted with obstructive sleep apnea (OSA) or depression. Conclusions: 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.

Published in Cerebral Circulation - Cognition and Behavior

ISSN: 2666-2450 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine; Medicine: Internal medicine: Neurosciences. Biological psychiatry. Neuropsychiatry
Website: https://www.journals.elsevier.com/cerebral-circulation-cognition-and-behavior

About the journal

Abstract

Keywords