Does Preferred Language Spoken Impact Neurologic Outcomes Post Stroke?

Spanish-only language preference among patients who are Mexican American correlates with adverse neurologic outcomes post stroke, according to study findings published in the journal Neurology.

Compared with non-Hispanic White individuals, Mexican Americans have been found to have worse neurologic, functional, and cognitive stroke outcomes. As data on preferred language use and stroke outcome is inconclusive, researchers aimed to examine whether language preference is associated with 90-day post stroke outcomes among Mexican Americans.

For the study, the researchers evaluated patients who were Mexican American and participated in the Brain Attack Surveillance in Corpus Christi (BASIC) project between 2009 and 2018. Those included had an ischemic or hemorrhagic stroke and survived 90 days post incident, as well as completed baseline and outcome interviews.

Primary outcomes included the National Institute of Health Stroke Scale (NIHSS), activities of daily living/instrumental activities of daily living (ADL/IADL), and the modified Mini-Mental State Examination (MSE). Patients were classified as either Spanish only speakers or others (English only or bilingual). Stroke outcomes categorized by English and Spanish speakers were examined using weighted Tobit regression.

A total of 1,096 patients who were Mexican American with a recorded first-ever stroke were included in the study, that of which 926 were English or bilingual speakers and 170 were Spanish speakers. Compared with English or bilingual speakers, Spanish speakers were found to be older (median age, 77 vs 64 years; P <.01), had higher initial NIHSS values (P = .02), and had a higher prevalence of atrial fibrillation (P <.01).

Fully adjusted models found that Spanish speakers had worse neurologic outcomes (mean difference, 1.93; 95% CI, 0.77 to 3.10; P <.01), but no notable difference in functional outcome (mean difference, 0.05; 95% CI, -0.12 to 0.22; P = .53), or cognitive outcome (mean difference, -1.28; 95% CI, -3.70 to 1.15;  P = 30).

After the researchers adjusted for immigration status, they found similar results, with the only significant difference being neurologic outcome (mean difference, 2.13; P <.01). As immigration status correlates to preferred interview language, multicollinearity within models was checked for immigration status, language preference, and level of education, however no relationship found.

“Our results demonstrate worse 90-day post stroke neurological outcomes among Spanish-only speaking MA [Mexican Americans] compared to MA who spoke English. We found no difference in 90-day post stroke cognitive or functional outcomes,” the researchers stated.

They concluded that “Improving the report of language preference and immigration status in stroke studies could help better characterize what is driving differences and disparities among populations.”

Study limitations included self-reported language preference and the lack of information on language used by providers to evaluate patient-provider language discordance.