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Impact of Language Barriers on Outcomes and Experience of COVID-19 Patients Hospitalized in Quebec, Canada, During the First Wave of the Pandemic

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Abstract

Language barriers (LB) contribute to coronavirus disease 2019 (COVID-19) health inequities. People with LB were more likely to be SARS-CoV-2 positive despite lower testing and had higher rates of hospitalization. Data on hospital outcomes among immigrants with LB, however, are limited. We aimed to investigate the clinical outcomes of hospitalized COVID-19 cases by LB, immigration status, ethnicity, and access to COVID-19 health information and services prior to admission. Adults with laboratory-confirmed community-acquired COVID-19 hospitalized from March 1 to June 30, 2020, at four tertiary-care hospitals in Montréal, Quebec, Canada were included. Demographics, comorbidities, immigration status, country of birth, ethnicity, presence of LB, and hospital outcomes (ICU admission and death) were obtained through a chart review. Additional socio-economic and access to care questions were obtained through a phone survey. A Fine-Gray competing risk subdistribution hazards model was used to estimate the risk of ICU admission and in-hospital death by immigrant status, region of birth and LB Among 1093 patients, 622 (56.9%) were immigrants and 101 (16.2%) of them had a LB. One third (36%) of immigrants with LB did not have access to an interpreter during hospitalization. Admission to ICU and in-hospital mortality were not significantly different between groups. Prior to admission, one third (14/41) of immigrants with LB had difficulties accessing COVID-19 information in their mother tongue and one third (9/27) of non-white immigrants with a LB had difficulties accessing COVID-19 services. Immigrants with LB were inequitably affected by the first wave of the pandemic in Quebec, Canada. In our study, a large proportion had difficulties accessing information and services related to COVID-19 prior to admission, which may have increased SARS-CoV-2 exposure and hospitalizations. After hospitalization, a large proportion did not have access to interpreters. Providing medical information and care in the language of preference of increasing diverse populations in Canada is important for promoting health equity.

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Data Availability

The datasets generated and/or analyzed during the current study are not publicly available due to compromise of patients’ privacy but are available from the corresponding author on reasonable request.

Abbreviations

COVID-19:

Coronavirus disease 2019

LB:

Language barriers

MSDI:

Material and Social Deprivation Index

NEWS2:

National Early Warning Score 2

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Acknowledgements

Dr. Azoulay holds a Chercheur-Boursier Senior Award from the Fonds de Recherche du Québec - Santé and is the recipient of a William Dawson Scholar award from McGill University. Dr. Passos-Castilho has received a postdoctoral fellowship from the Canadian Network on Hepatitis C (CanHepC). CanHepC is funded by a joint initiative of the Canadian Institutes of Health Research (NPC-178912) and the Public Health Agency of Canada.

Funding

This work was supported by an Investigator Initiated Grant from Gilead and the Jewish General Hospital Foundation.

Author information

Authors and Affiliations

  1. Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada

    Olina Dagher, Ana Maria Passos-Castilho, Laurent Azoulay & Christina Greenaway

  2. Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada

    Olina Dagher

  3. Department of Internal Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada

    Vasu Sareen

  4. Division of Infectious Diseases, Hôpital Maisonneuve-Rosemont, CIUSSS de l’Est-de-l’Île-de-Montréal, Montreal, QC, Canada

    Annie-Claude Labbé

  5. Department of Microbiology, Infectiology and Immunology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada

    Annie-Claude Labbé & Me-Linh Luong

  6. Division of Infectious Diseases, McGill University Health Center (MUHC), McGill University, Montreal, QC, Canada

    Sapha Barkati

  7. Research Institute of the McGill University Health Centre, Montreal, QC, Canada

    Sapha Barkati

  8. Department of Microbiology and Infectiology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada

    Me-Linh Luong

  9. Department of Psychiatry, McGill University Health Center, McGill University, Montreal, QC, Canada

    Cecile Rousseau

  10. SHERPA University Institute, CIUSSS du Centre-Ouest-de-l’Île-de-Montréal, Montreal, QC, Canada

    Cecile Rousseau

  11. Departments of Medicine and Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada

    Andrea Benedetti, Laurent Azoulay & Christina Greenaway

  12. Division of Infectious Disease, Jewish General Hospital, Montreal, QC, Canada

    Christina Greenaway

Authors
  1. Olina Dagher
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Contributions

Conceptualization: Christina Greenaway.

Data curation: Olina Dagher.

Formal analysis: Ana Maria Passos-Castilho.

Funding acquisition: Christina Greenaway.

Methodology: Christina Greenaway, Cecile Rousseau, Andrea Benedetti, Laurent Azoulay.

Project administration: Christina Greenaway.

Resources: Christina Greenaway, Annie-Claude Labbé, Sapha Barkati, Me-Linh Luong.

Writing - original draft: Christina Greenaway, Ana Maria Passos-Castilho, Olina Dagher, Vasu Sareen.

Writing - review & editing: Ana Maria Passos-Castilho, Annie-Claude Labbé, Sapha Barkati, Me-Linh Luong, Olina Dagher, Vasu Sareen, Cecile Rousseau, Andrea Benedetti, Laurent Azoulay, Christina Greenaway.

Corresponding author

Correspondence to Christina Greenaway.

Ethics declarations

Ethics Approval and Consent to Participate

This study was approved by the CIUSSS West-Central Montréal, the CIUSSS de l’Est-de-l’Île-de-Montréal, the McGill University Health Center, and the Centre hospitalier de l’Université de Montréal Review Ethics Boards.

Consent for Publication

Not applicable.

Competing interests

Dr. Azoulay reports personal fees from Janssen and Pfizer, outside the submitted work. Dr. Greenaway has provided consultations for AbbVie and has received investigator-initiated grants from Gilead. All other authors declare no competing interests.

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Dagher, O., Passos-Castilho, A.M., Sareen, V. et al. Impact of Language Barriers on Outcomes and Experience of COVID-19 Patients Hospitalized in Quebec, Canada, During the First Wave of the Pandemic. J Immigrant Minority Health 26, 3–14 (2024). https://doi.org/10.1007/s10903-023-01561-7

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