Language disparity is not a significant barrier for time-sensitive care of acute ischemic stroke
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RESEARCH ARTICLE
Open Access
Language disparity is not a significant barrier for time-sensitive care of acute ischemic stroke Noriko Anderson1†, Afra Janarious2†, Shimeng Liu2, Lisa A. Flanagan2, Dana Stradling2 and Wengui Yu2,3*
Abstract Background: Language barriers were reported to affect timely access to health care and outcome. The aim of this study was to investigate the effect of language disparity on quality benchmarks of acute ischemic stroke therapy. Methods: Consecutive patients with acute ischemic stroke at the University of California Irvine Medical Center from 2013 to 2016 were studied. Patients were categorized into 3 groups according to their preferred language: English, Spanish, and other languages. Quality benchmarks and outcomes of the 3 language groups were analyzed. Results: Of the 928 admissions, 69.7% patients recorded English as preferred language, as compared to 17.3% Spanish and 13.0% other languages. There was no significant difference in the rate of receiving intravenous thrombolysis (24.3, 22.1 and 21.0%), last-known-well to door time, door-to-imaging time, door-to-needle time, and hospital length of stay among the 3 language groups. In univariate analysis, the other languages group had lower chance of favorable outcomes than the English-speaking group (26.3% vs 40.4, p < 0.05) while the Spanish-speaking group had lower mortality rate than English-speaking group (3.1% vs 7.7%, p = 0.05). After adjusting for age and initial NIHSS scores, multivariate regression models showed no significant difference in favorable outcomes and mortality between different language groups. Conclusion: We demonstrate no significant difference in quality benchmarks and outcome of acute ischemic stroke among 3 different language groups. Our results suggest that limited English proficiency is not a significant barrier for time-sensitive stroke care at Comprehensive Stroke Center. Keywords: Acute ischemic stroke, Language disparity, Benchmark, Outcome, Thrombolysis
Background Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (tPA) remains the only proven medical therapy for acute ischemic stroke (AIS) [1]. An analysis of pooled data from clinical trials found that earlier the patient receives tPA, better the chances of recovery [2]. IVT rates in Get-With-The-Guideline (GWTG)-Stroke-participating hospitals have improved * Correspondence: [email protected] † Noriko Anderson and Afra Janarious contributed equally to this work. 2 Department of Neurology, University of California, Irvine, CA, USA 3 Orange, CA, USA Full list of author information is available at the end of the article
significantly over time [3]. However, a recent study reported that up to 18% potentially eligible patients were not being treated with IVT [4]. After adjusting for stroke severity, minorities remained more likely to not receive treatment [4, 5]. Thus, identification of the practice hurdles and development of improved system of care should be a high priority for stroke research. One of the possibilities for lower
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