Spanish-speaking adults may be less likely to receive a timely diagnosis of mild cognitive impairment compared with their English-speaking peers, suggests a study in the American Journal of Geriatric Psychiatry.
Jason A. Silva-Rudberg, M.D., of Yale University School of Medicine and colleagues analyzed data from the electronic medical records of 12,080 English- or Spanish-speaking patients who received an initial diagnosis of mild cognitive impairment or dementia between July 2017 and June 2019 when seeking care at the largest health system in Connecticut. Overall, 11,494 patients spoke English and 586 spoke Spanish. An initial diagnosis of mild cognitive impairment was classified as “timely,” and an initial diagnosis of dementia was considered “delayed.” The researchers also assessed the comprehensiveness of the evaluations that the patients received based on the presence of laboratory studies, neuroimaging, specialist evaluation, and advanced diagnostics six months before or after diagnosis.
During the study period, 3,096 patients were diagnosed with mild cognitive impairment, and 8,984 patients were diagnosed with dementia. At baseline, the mean age was 74.5 years for patients with mild cognitive impairment and 80.5 for patients with dementia.
Spanish speakers were 45% less likely to receive a timely diagnosis when compared with English speakers after adjusting for covariates such as sex, age, neighborhood disadvantage, ethnicity, and medical comorbidities. Despite being three years younger at presentation on average, only 18.6% of Spanish-speaking patients received a mild cognitive impairment diagnosis, compared with 26.0% of English-speaking patients.
English and Spanish speakers were equally likely to receive diagnostic services, except for referrals to geriatric services, which were more frequent among Spanish-speaking patients. A subgroup analysis of patients who identified as Hispanic/Latino revealed that Spanish speakers were 47% less likely to receive a timely diagnosis compared with English speakers.
“Our results demonstrate a significant inequity impacting Spanish-speaking patients and highlight the urgent need for interventions that increase access to interpretation services, health care, and improve cognitive evaluation for patients with [non-English language preference],” the researchers concluded.
For related information, see the Psychiatric Services article “Downward National Trends in Mental Health Treatment Offered in Spanish: State Differences by Proportion of Hispanic Residents.”
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