The role of spoken language in cardiovascular health inequalities: a cross-sectional study of people with non-English language preference

Alex Mackay; Mark Ashworth; Patrick White

doi:10.3399/bjgpopen17X101241

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Table 1. Demographic characteristics compared between English language preference and other language preference groups using means (t-tests) and sex proportions (χ²).

Language preference	Mean age, years (SD)	Males, %	Mean IMD score (SD)	Ethnic groups, % (two most frequent and ‘Not recorded’)	Country of birth, % (UK, most frequent, and ‘Not recorded’)
English n = 161 938	41.4 (16.0)	47.9	30.1 (8.4)	British or mixed British, 44.8; Other white, 17.0; Not recorded, 16.5	UK, 47.1; Jamaica, 4.1; Not recorded, 22.6
Non-English n = 47 790	38.9 (13.5)^a	48.2^a	32.1 (8.4)^a	Other white, 47.3; African, 13.9; Not recorded, 22.5	UK, 1; Portugal, 9.5; Poland, 7.5; Not recorded, 21.4
Portuguese n = 9862	38.9 (12.7)^a	49.3^a	33 (7.5)^a	Other white, 66.6; Other, 8.2; Not recorded, 11.3	UK, 0.5; Portugal, 46.4; Brazil, 24.5; Not recorded, 19.6
Spanish n = 7882	38.8 (12.3)^a	47.2^a	33.2 (7.9)^a	Other white, 50.1; Other, 26.5; Not recorded, 14.0	UK, 0.7; Colombia, 23.4; Spain, 20.7; Not recorded, 18.9
French n = 4968	36.5 (11.0)^a	48.5^a	32.1 (8.3)^a	African, 37.8; Other white, 36.0; Not recorded, 13.5	UK, 0.8; France, 39.9; Ivory Coast, 11.7; Not recorded, 21.1
Polish n = 4311	35.6 (11.1)^a	45.0^a	31 (7.9)^a	Other white, 90.3; British or mixed British, 5.7; Not recorded, 2.2	UK, 0.2; Poland, 81.9; Portugal, 0.3; Not recorded, 17.0
Somali n = 1567	39.3 (13.6)^a	43.7^a	34.6 (7.8)^a	African, 75.9; Other black, 16.5; Not recorded, 20.9	UK, 0.5; Somalia, 73.1; Not recorded, 25
Other n = 19 380	40.3 (14.9)^a	49.2^a	31.3 (7.9)^a	Other white, 33.7; African, 15.5; Not recorded, 38.6	UK, 1.7; Italy, 9.9; Pakistan, 4.4; Not recorded, 24.1
Not recorded n = 92 676	42.2 (14.9)^a	58.4^a	30.8 (8.7)^a	Unknown, 50.3; British or mixed British, 13.6; Not recorded, 13.4	UK, 1.5; Ghana, 0.7; Not recorded, 90.9

^a P <0.01 in comparison with English language preference groups.
IMD = Index of Multiple Deprivation, 2010. Not recorded = no data were received for patients in this category. SD = standard deviation.

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Table 2. Association between cardiovascular diagnosis and language preference (adjusted^a ORs with 95% Cs).

	Hypertension	CHD	DM	Stroke
	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)
English n = 161 938	1	1	1	1
Non-English n = 47 790	0.98 (0.92 to 1.03)	1.18 (1.03 to 1.34)^b	1.33 (1.23 to 1.43)^c	0.94 (0.8 to 1.11)
Portuguese n = 9862	1.43 (1.30 to 1.57)^c	1.29 (0.99 to 1.68)	1.74 (1.50 to 2.02)^c	1.40 (1.08 to 1.81)^b
Spanish n = 7882	0.83 (0.73 to 0.95)^c	0.8 (0.58 to 1.10)	1.12 (0.91 to 1.38)	0.86 (0.63 to 1.20)
French n = 4968	0.81 (0.70 to 0.95)^b	0.65 (0.40 to 1.06)	0.83 (0.65 to 1.04)	0.68 (0.40 to 1.15)
Polish n = 4311	1.33 (1.04 to 1.72)^b	1.23 (0.89 to 1.71)	0.75 (0.57 to 0.99)^b	0.77 (0.44 to 1.36)
Somali n = 1567	0.40 (0.32 to 0.50)^c	1.4 (0.67 to 2.86)	1.63 (1.34 to 1.98)^c	0.87 (0.47 to 1.60)
Other n = 19 380	0.92 (0.84 to 1.01)	1.34 (1.07 to 1.67)^c	1.42 (1.25 to 1.60)^c	0.84 (0.69 to 1.03)
Not recorded n = 92 676	0.98 (0.94 to 1.03)	1.07 (0.97to 1.17)	1.15 (1.08 to 1.22)^c	1.12 (1.00 to 1.25)^b

^aMultiple logistic regression adjusted for age, sex, socioeconomic deprivation, ethnicity, and practice clustering. ^b P<0.05. ^c P<0.01. CHD = coronary heart disease. DM = diabetes mellitus. OR= odds ratio.

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Table 3. Association between cardiovascular risk factors at the most recent measurement and language preferences (adjusted^a ORs with 95% CIs).

	Obesity OR (95% CI)	BP >150/90 mmHg OR (95% CI)	HBA1c >48 mmol/mol OR (95% CI)	Total cholesterol >5 mmol/l OR (95% CI)	Current smoker, yes or no OR (95% CI)
English	1 n = 134 639	1 n = 135 220	1 n = 10 545	1 n = 7349	1 n = 157 841
Non-English	1.08 (1.04 to 1.13)^c n = 38 755	0.93 (0.88 to 0.99)^b n = 38 196	0.94 (0.76 to 1.15) n = 2958	1.02 (0.83 to 1.24) n = 2194	1.18 (1.14 to 1.21)^c n = 46 404
Portuguese	1.53 (1.36 to 1.73)^c n = 7785	1.12 (0.95 to 1.29) n = 7841	1.13 (0.88 to 1.45) n = 575	0.89 (0.59 to 1.33) n = 214	1.13 (1.02 to 1.25)^b n = 9360
Spanish	1.21 (1.09 to 1.34)^c n = 6304	0.65 (0.55 to 0.77)^c n = 6146	0.93 (0.65 to 1.31) n = 416	1.30 (0.90 to 1.90) n = 216	0.79 (0.7 to 0.88)^c n = 7626
French	0.75 (0.69 to 0.82)^c n = 4007	0.78 (0.66 to 0.93)^c n = 3887	0.73 (0.51 to 1.02) n = 225	0.65 (0.39 to 1.08) n = 132	1.43 (1.3 to 1.57)^c n = 4802
Polish	1.03 (0.84 to 1.26) n = 3392	1.72 (1.46 to 2.01)^c n = 3168	0.90 (0.50 to 1.63) n = 98	0.51 (0.24 to 1.08) n = 86	1.38 (1.25 to 1.52)^c n = 4194
Somali	1.12 (0.95 to 1.31) n = 1256	0.61 (0.50 to 0.73)^c n = 1371	1.09 (0.75 to 1.60) n = 135	1.8 (0.81 to 3.98) n = 60	1.34 (1.05 to 1.70)^b n = 1528
Other	0.91 (0.85 to 0.98)^c n = 16 011	0.86 (0.77 to 0.95)^c n = 15 783	1.08 (0.86 to 1.35) n = 1509	1.05 (0.77 to 1.43) n = 1516	1.31 (1.22 to 1.40)^c n = 18 894
Not recorded	1.14 (1.10 to 1.18)^c n = 62 116	1.05 (1.00 to 1.10)^b n = 68 872	1.13 (0.97 to 1.32) n = 4944	0.99 (0.86 to 1.14) n = 3534	1.28 (1.24 to 1.31)^c n = 80 066

^aMultiple logistic regression adjusted for age, sex, socioeconomic deprivation, ethnicity and practice clustering. ^*b P<0.05. ^c P<0.01.
BP = blood pressure. HbA1c = glycated haemoglobin. OR = odds ratio.

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Table 4. Association between cardiovascular monitoring recorded within a set interval and language preference (adjusted^a ORs with 95% confidence intervals).

	Smoking cessation history recorded within 15 months, OR (95% CI)	BP recorded within 9 months, OR (95% CI)	Cholesterol recorded within 15 months, OR (95% CI)	HbA1c recorded within 15 months, OR (95% CI)
English n = 161 938	1 n = 60 046	1 n = 135 228	1 n = 7467	1 n = 151 101
Non-English n = 47 790	1.06 (1.01 to 1.11)^b n = 16 707	0.98 (0.95 to 1.02) n = 38 199	1.02 (0.88 to 1.19) n = 2207	1.09 (0.93 to 1.28) n = 3047
Portuguese n = 9862	1.24 (0.96 to 1.59) n = 3844	1.17 (0.97 to 1.4) n = 7841	1.17 (0.8 to 1.71) n = 215	1.43 (0.91 to 2.24) n = 581
Spanish n = 7882	1.03 (0.83 to 1.28) n = 2713	0.93 (0.84 to 1.02) n = 6147	1.38 (0.89 to 2.13) n = 220	0.95 (0.66 to 1.36) n = 419
French n = 4968	0.87 (0.76 to 0.99)^b n = 1688	0.73 (0.67 to 0.8)^c n = 3887	0.87 (0.62 to 1.22) n = 133	0.92 (0.62 to 1.37) n = 232
Polish n = 4311	1.12 (0.76 to 1.65) n = 1701	0.94 (0.79 to 1.13) n = 3168	1.2 (0.66 to 2.18) n = 56	1.17 (0.56 to 2.47) n = 98
Somali n = 1567	1.14 (0.8 to 1.61) n = 443	0.95 (0.8 to 1.1) n = 1371	0.68 (0.38 to 1.22) n = 60	1.01 (0.65 to 1.57) n = 139
Other n = 19 380	0.98 (0.84 to 1.16) n = 6318	0.99 (0.91 to 1.08) n = 15 785	0.92 (0.73 to 1.17) n = 1523	1.03 (0.84 to 1.26) n = 1578
Not recorded n = 92 676	1.06 (1.02 to 1.11)^c n = 30 372	0.86 (0.84 to 0.89)^c n = 68 876	1.29 (1.16 to 1.42)^c n = 3584	0.98 (0.87 to 1.11) n = 5094

^aMultiple logistic regression adjusted for age, sex, socioeconomic deprivation, ethnicity and practice clustering. ^b P<0.05. ^c P<0.01. BP = blood pressure. OR = odds ratio.