Background

Limited English proficiency has been shown to negatively affect health outcomes. However, as of now, little is known about survival rates of patients with limited English proficiency (LEP) and pancreatic ductal adenocarcinoma (PDAC) when compared to patients with English proficiency (EP) in an urban, non-safety net setting. We aimed to compare survival rates between patients with LEP and those with EP who had a diagnosis of PDAC.

Methods

A single-institution retrospective propensity-matched cohort study of patients with biopsy-proven PDAC was undertaken. Demographics, clinical characteristics, and language information were collected for all participants. Patients were classified as having LEP or EP based on their preferred speaking language at the time of admission and matched on baseline characteristics using propensity scores. Survival analysis methods were used to study survival rates in patients with PDAC based on their EP status.

Results

Of 739 included patients, 71 (9.48%) had LEP, mean age was 68.4 ± 10.9, and 51.8% were female. Both groups of patients were comparable for age, gender, marital status, and time to treatment. LEP status was associated with higher odds of death in both unmatched (HR 1.65, 95% CI 1.22–2.22) and matched (HR 1.60, 95% CI 1.03–2.47) analyses. Additionally, patients with LEP had significantly decreased odds of receiving cancer-directed treatment and increased odds of advanced stage cancer at presentation.

Conclusions

In this cohort of patients with PDAC, LEP predicted worse survival. The results of this study suggest that, after accounting for interpreter use, other factors contribute to this disparity. Such factors, as yet unmeasured, may include health literacy and cultural expectations, for which further investigation is warranted to better understand and limit this survival disparity.

中文翻译：

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胰腺癌的语言能力和生存率：倾向评分匹配分析

 背景

有限的英语水平已被证明会对健康结果产生负面影响。然而，到目前为止，对于城市非安全网环境中英语水平有限 (LEP) 和胰腺导管腺癌 (PDAC) 患者与英语水平 (EP) 患者相比的生存率知之甚少。我们的目的是比较 LEP 患者和诊断为 PDAC 的 EP 患者之间的生存率。

 方法

对经活检证实患有 PDAC 的患者进行了一项单机构回顾性倾向匹配队列研究。收集所有参与者的人口统计、临床特征和语言信息。根据入院时患者的首选语言，将患者分为 LEP 或 EP，并使用倾向评分匹配基线特征。使用生存分析方法根据 PDAC 患者的 EP 状态研究其生存率。

 结果

在 739 名患者中，71 名（9.48%）患有 LEP，平均年龄为 68.4 ± 10.9 岁，51.8% 为女性。两组患者的年龄、性别、婚姻状况和治疗时间具有可比性。在未匹配分析（HR 1.65，95% CI 1.22-2.22）和匹配分析（HR 1.60，95% CI 1.03-2.47）中，LEP 状态与较高的死亡几率相关。此外，LEP 患者接受癌症定向治疗的几率显着降低，而就诊时患晚期癌症的几率增加。

 结论

在这组 PDAC 患者中，LEP 预测生存率较差。这项研究的结果表明，在考虑了口译员的使用后，其他因素也造成了这种差异。这些尚未衡量的因素可能包括健康素养和文化期望，对此需要进一步调查，以更好地理解和限制这种生存差异。