Major disparities in COVID-19 test positivity for patients with non-English preferred language even after accounting for race and social factors in the United States in 2020.

Publication Title

BMC public health [electronic resource]

Authors

Hannah Cohen-Cline, Center for Outcomes Research and Education, Providence St. Joseph Health, 5251 NE Glisan St., Portland, OR, 97213, USAFollow
Hsin-Fang Li, Cardiovascular Analytics, Research, and Data Science, Providence St. Joseph Health, 9205 SW Barnes Road, Portland, OR, 97225, USAFollow
Monique Gill, Center for Outcomes Research and Education, Providence St. Joseph Health, 5251 NE Glisan St., Portland, OR, 97213, USAFollow
Fatima Rodriguez
Tina Hernandez-Boussard
Harry Wolberg, Clinical Analytics, Providence St. Joseph Health, 1801 Lind Ave SW, Renton, WA, 98057, USAFollow
Jacob Lippa, Clinical Analytics, Providence St. Joseph Health, 1801 Lind Ave SW, Renton, WA, 98057, USAFollow
Keri B Vartanian, Providence Health & Services, Center for Outcomes Research and Education, 5251 NE Glisan Street, Portland, OR 97213, United StatesFollow

Document Type

Article

Publication Date

11-18-2021

Keywords

cards publication; covid-19; oregon; portland; psjh_core; Adult; COVID-19; Ethnicity; Humans; Language; Pandemics; Retrospective Studies; SARS-CoV-2; Social Factors; United States

Abstract

BACKGROUND: The COVID-19 pandemic has further exposed inequities in our society, demonstrated by disproportionate COVID-19 infection rate and mortality in communities of color and low-income communities. One key area of inequity that has yet to be explored is disparities based on preferred language.

METHODS: We conducted a retrospective cohort study of 164,368 adults tested for COVID-19 in a large healthcare system across Washington, Oregon, and California from March - July 2020. Using electronic health records, we constructed multi-level models that estimated the odds of testing positive for COVID-19 by preferred language, adjusting for age, race/ethnicity, and social factors. We further investigated interaction between preferred language and both race/ethnicity and state. Analysis was performed from October-December 2020.

RESULTS: Those whose preferred language was not English had higher odds of having a COVID-19 positive test (OR 3.07, p < 0.001); this association remained significant after adjusting for age, race/ethnicity, and social factors. We found significant interaction between language and race/ethnicity and language and state, but the odds of COVID-19 test positivity remained greater for those whose preferred language was not English compared to those whose preferred language was English within each race/ethnicity and state.

CONCLUSIONS: People whose preferred language is not English are at greater risk of testing positive for COVID-19 regardless of age, race/ethnicity, geography, or social factors - demonstrating a significant inequity. Research demonstrates that our public health and healthcare systems are centered on English speakers, creating structural and systemic barriers to health. Addressing these barriers are long overdue and urgent for COVID-19 prevention.

Specialty/Research Institute

Infectious Diseases