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

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.

Monthly excess mortality across counties in the United States during the Covid-19 pandemic, March 2020 to February 2022

“…The elimination of this gap by 2021 suggests that as the pandemic progressed, the Mideast was able to more effectively and fully capture Covid-19 deaths. In other regions such as the Southeast and Southwest, the gaps between Covid-19 and excess mortality persisted into 2021, which may relate to the continued lack of Covid-19 testing in many Southeastern and Southwestern counties even as the pandemic progressed (26–28).…”

“…It is also possible that some indirect effects of the pandemic, such as disruptions in health care access, also decreased during this time. In other regions such as the Southeast and Southwest, the gaps between Covid-19 and excess mortality persisted into 2021, which may relate to the continued lack of Covid-19 testing in many Southeastern and Southwestern counties even as the pandemic progressed (32)(33)(34). (19,25).…”

Exploring spatial distribution of social vulnerability and its relationship with the Coronavirus disease 2019: the Capital region of South Korea

“…The following factors are considered in SVI: socioeconomic, housing composition, minority status and language, and accessibility to housing and transportation [ 37 , 49 , 50 ]. The Centers for Disease Control and Prevention in the United States (US CDC) created an SVI considering the external stresses on human health [ 51 ].…”

Patient experience and healthcare utilization for a COVID-19 telemedicine home monitoring program offered in English and Spanish

“…For example, within an academic health system, not being an English speaker was associated with lower odds of completing telemedicine visits [ 13 ]. This is particularly concerning for the implementation of COVID-19 telemedicine HMPs as extensive data demonstrates the disproportionate impact of COVID-19 infection on people of color and those whose primary preferred language is not English [ 14 – 18 ]. Studies have shown twice the odds of testing positive for COVID-19 for Hispanic/Latino patients and among individuals whose primary preferred language is not English [ 15 , 16 , 18 ].…”

“…This is particularly concerning for the implementation of COVID-19 telemedicine HMPs as extensive data demonstrates the disproportionate impact of COVID-19 infection on people of color and those whose primary preferred language is not English [ 14 – 18 ]. Studies have shown twice the odds of testing positive for COVID-19 for Hispanic/Latino patients and among individuals whose primary preferred language is not English [ 15 , 16 , 18 ]. Thus, to overcome barriers to care, it is essential that telemedicine is offered in multiple languages and meets the needs of these populations.…”