Hypertension is a major modifiable risk factor for cardiovascular disease and a leading cause of morbidity and mortality worldwide. Despite stable age-adjusted prevalence over the past three decades, the absolute number of people with hypertension has doubled, affecting about one-third of the global adult population. Poorly controlled hypertension remains a significant public health issue, contributing to frequent physician visits and substantial healthcare costs.
Language barriers have been identified as a social determinant of health, affecting chronic disease management. Studies show that non–English-speaking patients with diabetes, hypertension, and dyslipidaemia have better health outcomes when treated by physicians who speak their preferred language (language-concordant care) compared to those receiving care in English (language-discordant care). However, previous studies have not specifically examined language concordance in relation to long-term complications of chronic diseases.
A new study investigated the impact of patient-physician language concordance on major adverse cardiovascular events (MACEs) among Canadians with hypertension, hypothesising that language-concordant care leads to better health outcomes. The study analysed adults with self-reported hypertension from the Canadian Community Health Survey (2003–2014), excluding Quebec residents. Survey responses were linked to hospitalisation and mortality records, with data analysed from October 2023 to May 2024.
Primary home language was determined by the language spoken most often at home. Patient-physician language concordance was assessed based on the language spoken with their regular physician. Respondents who communicated with their physician in their primary home language were classified as receiving language-concordant care, while others were classified as receiving language-discordant care. The main outcome measured was MACEs within five years of survey completion.
Among 124,583 patients, 91.7% spoke English, 3.8% spoke French, 0.3% spoke an Indigenous language, and 4.2% spoke another language (allophone). The average age was 63.7 years, and 57.1% were female. Few Indigenous language speakers (<4.6%) received language-concordant care. For French-speaking patients, language concordance did not significantly impact MACE risk. However, allophone-speaking patients who received language-concordant care had a 36% lower risk of MACE compared to those who received language-discordant care.
The findings suggest that cultural and language barriers may contribute to disparities in healthcare quality, impacting trust, history-taking, diagnosis, and treatment. Language concordance is linked to better medical comprehension, adherence to care, and improved health outcomes.
For francophone patients, language concordance did not significantly affect cardiovascular outcomes, likely due to federal and provincial policies ensuring access to bilingual healthcare and potential misclassification of language preference. Many francophones may also have greater functional bilingualism than allophones, reducing the impact of language discordance.
Indigenous language speakers were less likely to have a regular physician and rarely received care in their home language. This disparity is linked to geographic, socioeconomic, and systemic barriers, including colonial policies and institutional racism, that have eroded Indigenous language use and trust in healthcare systems.
This study identified significant disparities in access to language-concordant care and cardiovascular outcomes among hypertensive patients in minority language communities across Canada. Findings suggest that improving language-concordant care could reduce negative cardiovascular events and healthcare utilisation. To address these disparities, the study emphasises the need for equitable access to medical education for minority language communities and systematic data collection on patient and provider language proficiency to better match patients with linguistically proficient healthcare professionals.
Source: JAMA
Image Credit: iStock
