title: Patient-provider language concordance and colorectal cancer screening.
abstract: OBJECTIVE
  Patient-provider language barriers may play a role in health-care disparities, including obtaining colorectal cancer (CRC) screening. Professional interpreters and language-concordant providers may mitigate these disparities. DESIGN, SUBJECTS, AND MAIN MEASURES: We performed a retrospective cohort study of individuals age 50 years and older who were categorized as English-Concordant (spoke English at home, n = 21,594); Other Language-Concordant (did not speak English at home but someone at their provider's office spoke their language, n = 1,463); or Other Language-Discordant (did not speak English at home and no one at their provider's spoke their language, n = 240). Multivariate logistic regression assessed the association of language concordance with colorectal cancer screening.
  
  
  RESULTS
  Compared to English speakers, non-English speakers had lower use of colorectal cancer screening (30.7% vs 50.8%; OR, 0.63; 95% CI, 0.51-0.76). Compared to the English-Concordant group, the Language-Discordant group had similar screening (adjusted OR, 0.84; 95% CI, 0.58-1.21), while the Language-Concordant group had lower screening (adjusted OR, 0.57; 95% CI, 0.46-0.71).
  
  
  CONCLUSIONS
  Rates of CRC screening are lower in individuals who do not speak English at home compared to those who do. However, the Language-Discordant cohort had similar rates to those with English concordance, while the Language-Concordant cohort had lower rates of CRC screening. This may be due to unmeasured differences among the cohorts in patient, provider, and health care system characteristics. These results suggest that providers should especially promote the importance of CRC screening to non-English speaking patients, but that language barriers do not fully account for CRC screening rate disparities in these populations.
authors.affiliation: General Internal Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, GIM, Boston, MA, USA. Amy.Linsky@bmc.org
authors.forename: Amy
authors.initials: A
authors.lastname: Linsky
authors.forename: Nathalie
authors.initials: N
authors.lastname: McIntosh
authors.forename: Howard
authors.initials: H
authors.lastname: Cabral
authors.forename: Lewis E
authors.initials: LE
authors.lastname: Kazis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology; D003144:Communication Barriers; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007802:Language; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D012189:Retrospective Studies