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. 2016 May;68(5):621-8.
doi: 10.1002/acr.22748.

Poverty, Depression, or Lost in Translation? Ethnic and Language Variation in Patient-Reported Outcomes in Rheumatoid Arthritis

Patricia P Katz  1 , Jennifer Barton  2 , Laura Trupin  1 , Gabriela Schmajuk  1 , Jinoos Yazdany  1 , Pedro J Ruiz  3 , Edward Yelin  1
Affiliations

Poverty, Depression, or Lost in Translation? Ethnic and Language Variation in Patient-Reported Outcomes in Rheumatoid Arthritis

Patricia P Katz et al. Arthritis Care Res (Hoboken). 2016 May.

Abstract

Objective: Despite advances in therapies, disparities in outcomes have been documented for rheumatoid arthritis (RA) patients for both ethnicity and English language proficiency. The goals of these analyses were to compare differences in RA patient-reported outcomes, by both self-identification of ethnicity and English language proficiency, and to identify factors that might explain differences among groups.

Methods: Data were collected through structured telephone interviews of a longitudinal cohort with physician-diagnosed RA (n = 438); only women were included (n = 335). Three groups were defined based on self-reported ethnicity and English proficiency: white/English (n = 219), Hispanic/English (n = 39), and Hispanic/Spanish (n = 77). Outcomes examined were patient-reported physical functioning, pain, and presence of moderate or severe fatigue. Multivariate regression analyses compared outcomes among groups, adjusting for sociodemographic characteristics, health and disease factors, and depression.

Results: Hispanic/Spanish women had worse function, pain, and fatigue than either English-proficient group. Depression was associated with all outcomes (P < 0.0001), and accounted for greater differentials in scores than ethnicity/language proficiency. In interaction analyses, differences between women who were and were not depressed were greater for Hispanic/English than for Hispanic/Spanish. Nondepressed Hispanic/Spanish scores were significantly worse than nondepressed Hispanic/English, i.e., the impact of depression was less for Hispanic/Spanish women because both depressed and nondepressed women in this group reported worse outcomes. After adjustment for sociodemographic factors and depression, language remained significantly associated with outcomes.

Conclusion: Disparities in patient-reported outcomes may be driven less by ethnicity than by sociodemographic or psychological factors. Measurement instruments that are not culturally appropriate and equivalent may also hamper meaningful analyses of disparities.

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Figures

Figure 1
Figure 1. Impact of depression on patient-reported outcomes
Note: All differences between not depressed and depressed significant at p<.0001. From multiple regression analyses adjusting for ethnicity, language, other sociodemographic characteristics (age, income, education, health insurance, health literacy), and additional health and disease characteristics (comorbid conditions, RA duration, medication use).
Figure 2
Figure 2. Adjusted mean scores for RA outcomes for English-speaking and Spanish-speaking Hispanic women: Illustration of interactions
Note: From multiple regression analyses adjusting for ethnicity, language, other sociodemographic characteristics (age, income, health insurance, health literacy), and additional health and disease characteristics (comorbid conditions, RA duration, medication use).
See this image and copyright information in PMC

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