Analysis: COVID-19 vaccination and clinical outcomes are associated with patients’ preferred language

Doctor takes the blood pressure of a woman wearing hijab

Collaborators from the University of Minnesota and HealthPartners Institute published an analysis Wednesday demonstrating that people with language preferences other than English, and those needing interpreters, were more likely to experience delays in COVID-19 vaccination, and become hospitalized and die from COVID-19 compared to their English-speaking peers. 

According to the authors, unmet language access needs are a key barrier to high-quality healthcare and health equity, as seen with COVID-19, but also widely applicable to other health conditions. However, to date no large-scale study has investigated clinical outcomes for any medical condition based on patients' preferred language and need for an interpreter. By investigating time to vaccination for COVID-19, and the associated disease outcomes of hospitalization and death, the authors found a clear association in a health system of almost one million patients. This is the first large-scale study in the US to demonstrate that a patient’s language, and need for an interpreter, are associated with clinical outcomes. This study suggests that routine data collection of a patient’s preferred language and interpreter needs should be standard of practice and could provide key information on improving health equity in the US.

Language Justice and Health Equity

Language justice is a framework centering the fundamental right of people to communicate in their preferred language and is of increasing importance in a multilingual society. Healthcare communication during the pandemic has been a challenge for all communities, and has been particularly difficult for some refugee, immigrant, and migrant (RIM) communities. Providing medically trained interpreters improves clinical care, and while offering these services is standard of care, and a legal requirement, appropriate use of interpreters is still limited. Public health messages must also be delivered in a culturally and linguistically appropriate manner to be effective, and yet many health systems and most public health agencies do not collect basic data on language. This makes identifying disparities within specific linguistic groups difficult. Ensuring access to language services for patients and communities is crucial for public health and health systems as they pursue health equity and language justice. 

“It is time to look beyond language access and instead pursue language justice,” said Dr. Nasreen Quadri, lead author and physician collaborator with the National Resource Center for Refugees, Immigrants and Migrants. “In a healthcare setting, language is more than a communication tool. It conveys respect, upholds a patient’s dignity, and gives patients autonomy over their care.”

The delayed exchange of health information that comes with language barriers leads to delayed care, decreased access, delayed or incorrect treatment, and increases the overall cost of healthcare. This study definitively demonstrates what has long been suspected, and shown in smaller analysis: language access plays a role in patient outcomes with certain groups suffering increased morbidity and death. In this study, patients with preferred languages other than English experienced delays in receiving their first COVID-19 vaccine dose and were twice as likely to be hospitalized or die. While the analysis utilized the large cohort of patients affected by COVID-19 to investigate the hypothesis of the association of language to clinical outcomes, the authors suspect this is true with most major diseases from infectious diseases (e.g. influenza) to non-communicable diseases (e.g. diabetes), and even to the provision of preventive care. 

From Data to Actionable Solutions

The authors state that the most common method for describing health disparities in the U.S. is through racial and ethnic categories, and yet these categories provide little practical information on how to address the disparities within these traditional racial and ethnicity groupings. Systematically collecting data on language preference and interpreter needs assists with unmasking specific groups within each race and ethnicity category who are at disproportionately high risk of health inequities. The added benefit is providing actionable information that can assist in the development of culturally and linguistically appropriate interventions. This information can be immediately useful for:

  • Creating and disseminating linguistically and culturally relevant health education
  • Identifying, partnering and engaging with linguistic communities 
  • Forging relevant community partnerships and finding trusted messengers
  • Developing culturally appropriate interventions
  • Provision of medically trained interpreters in clinical settings

For more information on the analysis, view the full article in JAMA Network Open.