Language barriers and kidney transplantation in children.
Interpreter
Kidney transplant
Language barrier
Limited English proficiency
Pediatric
Journal
Pediatric nephrology (Berlin, Germany)
ISSN: 1432-198X
Titre abrégé: Pediatr Nephrol
Pays: Germany
ID NLM: 8708728
Informations de publication
Date de publication:
07 2023
07 2023
Historique:
received:
01
06
2022
accepted:
03
11
2022
revised:
02
11
2022
medline:
5
6
2023
pubmed:
13
12
2022
entrez:
12
12
2022
Statut:
ppublish
Résumé
Understanding disparities in pediatric kidney transplants is important to provide equitable care. We compared transplant outcomes between English-speaking (ES) and interpreter-needing (IN) pediatric kidney transplant recipients. Through retrospective review, primary kidney transplant recipients, 0-21 years transplanted between 2005 and 2019, were divided into ES and IN cohorts. Continuous and categorical variables were compared using Wilcoxon rank-sum, Welch two-sample t-test, and chi-squared analyses. Patient survival, graft survival, and rejection-free survival were evaluated using Kaplan-Meier methods and Cox regression. Days hospitalized were evaluated using negative binomial regression. Our sample included 211 ES and 37 IN transplant recipients. Compared with the ES, the IN cohort was older at transplant (14.56 vs. 11.03 years; p < 0.01), had more time between kidney failure and transplant (0.9 vs. 0.3 years; p < 0.01), and more often received deceased over living donor transplants (78.4% vs. 30.4%; p < 0.01). Multivariate Cox proportional-hazard models evaluating adjusted 5-year patient survival demonstrated decreased 5-year post-transplant survival in the IN cohort (aHR = 10.10, 95% CI: 1.5, 66.8; p = 0.02). We did not identify differences in 5-year death-censored graft survival (aHR = 0.57; 95% CI: 0.14, 2.4; p = 0.4) nor rejection-free survival (aHR = 0.8; 95% CI: 0.4, 1.5; p = 0.5). We found significantly fewer hospitalization events in the IN cohort during the first year post-transplant (aRR: 0.62; 95% CI: 0.4, 0.9; p = 0.01) but no difference 5-year post-transplant. The IN cohort had more missed outpatient appointments (10.4% vs. 2.8%; p = 0.03) and undetectable serum immunosuppressant levels (mean: 3.8% vs. 1.3%; p = 0.02) 5 years post-transplant. Pediatric kidney transplant recipients requiring interpreter services for healthcare delivery demonstrate fewer post-transplant interactions with their healthcare team (fewer hospitalizations and more no-show visits) and lower 5-year patient survival compared with recipients not requiring interpreters. A higher resolution version of the Graphical abstract is available as Supplementary information.
Sections du résumé
BACKGROUND
Understanding disparities in pediatric kidney transplants is important to provide equitable care. We compared transplant outcomes between English-speaking (ES) and interpreter-needing (IN) pediatric kidney transplant recipients.
METHODS
Through retrospective review, primary kidney transplant recipients, 0-21 years transplanted between 2005 and 2019, were divided into ES and IN cohorts. Continuous and categorical variables were compared using Wilcoxon rank-sum, Welch two-sample t-test, and chi-squared analyses. Patient survival, graft survival, and rejection-free survival were evaluated using Kaplan-Meier methods and Cox regression. Days hospitalized were evaluated using negative binomial regression.
RESULTS
Our sample included 211 ES and 37 IN transplant recipients. Compared with the ES, the IN cohort was older at transplant (14.56 vs. 11.03 years; p < 0.01), had more time between kidney failure and transplant (0.9 vs. 0.3 years; p < 0.01), and more often received deceased over living donor transplants (78.4% vs. 30.4%; p < 0.01). Multivariate Cox proportional-hazard models evaluating adjusted 5-year patient survival demonstrated decreased 5-year post-transplant survival in the IN cohort (aHR = 10.10, 95% CI: 1.5, 66.8; p = 0.02). We did not identify differences in 5-year death-censored graft survival (aHR = 0.57; 95% CI: 0.14, 2.4; p = 0.4) nor rejection-free survival (aHR = 0.8; 95% CI: 0.4, 1.5; p = 0.5). We found significantly fewer hospitalization events in the IN cohort during the first year post-transplant (aRR: 0.62; 95% CI: 0.4, 0.9; p = 0.01) but no difference 5-year post-transplant. The IN cohort had more missed outpatient appointments (10.4% vs. 2.8%; p = 0.03) and undetectable serum immunosuppressant levels (mean: 3.8% vs. 1.3%; p = 0.02) 5 years post-transplant.
CONCLUSIONS
Pediatric kidney transplant recipients requiring interpreter services for healthcare delivery demonstrate fewer post-transplant interactions with their healthcare team (fewer hospitalizations and more no-show visits) and lower 5-year patient survival compared with recipients not requiring interpreters. A higher resolution version of the Graphical abstract is available as Supplementary information.
Identifiants
pubmed: 36508051
doi: 10.1007/s00467-022-05821-w
pii: 10.1007/s00467-022-05821-w
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
2209-2219Subventions
Organisme : NCATS NIH HHS
ID : UL1TR002494
Pays : United States
Organisme : NCI NIH HHS
ID : T32 CA009138
Pays : United States
Organisme : NIGMS NIH HHS
ID : T32 GM008244
Pays : United States
Organisme : NCI NIH HHS
ID : F30 CA228261
Pays : United States
Informations de copyright
© 2022. The Author(s), under exclusive licence to International Pediatric Nephrology Association.
Références
United Nations Platform on Social Determinants of Health (2016) Health in the post-2015 development agenda: need for a social determinants of health approach. World Health Organization. https://www.who.int/publications/m/item/health-in-the-post-2015-development-agenda-need-for-a-social-determinants-of-health-approach . Accessed 30 May 2022
Gitterman BA, Flanagan PJ, Cotton WH, Dilley KJ, Duffee JH, Green AE, Keane VA, Krugman SD, Linton JM, McKelvey CD, Nelson JL, Council of Community Pediatrics (2016) Poverty and child health in the United States. Pediatrics 137:e20160339. https://doi.org/10.1542/peds.2016-0339
doi: 10.1542/peds.2016-0339
Stevens MA, Beebe TJ, Wi CI, Taler SJ, St Sauver JL, Juhn YJ (2020) HOUSES index as an innovative socioeconomic measure predicts graft failure among kidney transplant recipients. Transplantation 104:2383–2392. https://doi.org/10.1097/TP.0000000000003131
doi: 10.1097/TP.0000000000003131
pubmed: 31985729
pmcid: 8159015
Hensley CG, Real FJ, Walsh KE, Klein MD, Beck AF (2018) Tackling the social determinants of health: a critical component of safe and effective healthcare. Pediatr Qual Saf 3:e054. https://doi.org/10.1097/pq9.0000000000000054
doi: 10.1097/pq9.0000000000000054
pubmed: 30280123
pmcid: 6132767
Cohen AL, Rivara F, Marcuse EK, McPhillips H, Davis R (2005) Are language barriers associated with serious medical events in hospitalized pediatric patients? Pediatrics 116:575–579. https://doi.org/10.1542/peds.2005-0521
doi: 10.1542/peds.2005-0521
pubmed: 16140695
Flores G (2014) Families facing language barriers in healthcare: when will policy catch up with the demographics and evidence. J Pediatr 164:1261–1264. https://doi.org/10.1016/j.jpeds.2014.02.033
doi: 10.1016/j.jpeds.2014.02.033
pubmed: 24721469
Federal Interagency Forum on Child and Family Statistics (2021) America’s children: key national indicators of well-being. U.S. Government Printing Office. https://www.childstats.gov/pdf/ac2021/ac_21.pdf . Accessed 30 May 2022
Civil Rights Act § 6, 42 U.S.C. § 2000d et seq (1964)
Exec. Order No. 13166, 65 Fed. Reg. 50121 (Aug 11, 2000)
Boylen S, Cherian S, Gill F, Leslie G, Wilson S (2020) Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: a systematic review. JBI Evid Synth 18:1360–1388. https://doi.org/10.11124/JBISRIR-D-19-00300
doi: 10.11124/JBISRIR-D-19-00300
pubmed: 32813387
Fields A, Abraham M, Gaughan J, Haines C, Sarah Hoehn K (2016) Language matters: race, trust, and outcomes in the pediatric emergency department. Pediatr Emerg Care 32:222–226. https://doi.org/10.1097/PEC.0000000000000453
doi: 10.1097/PEC.0000000000000453
pubmed: 27031004
Steinberg EM, Valenzuela-Araujo D, Zickafoose JS, Kieffer E, DeCamp LR (2016) The “battle” of managing language barriers in health care. Clin Pediatr (Phila) 55:1318–1327. https://doi.org/10.1177/0009922816629760
doi: 10.1177/0009922816629760
pubmed: 26896341
Hampers LC, Cha S, Gutglass DJ, Binns HJ, Krug SE (1999) Language barriers and resource utilization in pediatric emergency department. Pediatrics 103:1253–1256. https://doi.org/10.1542/peds.103.6.1253
doi: 10.1542/peds.103.6.1253
pubmed: 10353938
Khan A, Yin H, Brach C, Graham D, Ramotar M, Williams D, Spector N, Landrigan C, Dreyer B (2020) Association between parent comfort with English and adverse events among hospitalized children. JAMA Pediatr 174:e203215. https://doi.org/10.1001/jamapediatrics.2020.3215
doi: 10.1001/jamapediatrics.2020.3215
pubmed: 33074313
pmcid: 7573792
de Jong RW, Stel VS, Heaf JG, Murphy M, Massy ZA, Jagger KJ (2021) Non-medical barriers reported by nephrologists when providing renal replacement therapy or comprehensive conservative management to end-stage kidney disease patients: a systematic review. Nephrol Dial Transplant 36:848–862. https://doi.org/10.1093/ndt/gfz271
doi: 10.1093/ndt/gfz271
pubmed: 31898742
Cervantes L, Jones J, Linas S, Fischer S (2017) Qualitative interviews exploring palliative care perspectives of Latinos on dialysis. Clin J Am Soc Nephrol 12:788–798. https://doi.org/10.2215/CJN.10260916
doi: 10.2215/CJN.10260916
pubmed: 28404600
pmcid: 5477217
Talamantes E, Norris KC, Mangione CM, Moreno G, Waterman AD, Peipert JD, Bunnapradist S, Huang E (2017) Linguistic isolation and access to the active kidney transplant waiting list in the United States. Clin J Am Soc Nephrol 12:483–492. https://doi.org/10.2215/CJN.07150716
doi: 10.2215/CJN.07150716
pubmed: 28183854
pmcid: 5338711
Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637. https://doi.org/10.1681/ASN.2008030287
doi: 10.1681/ASN.2008030287
pubmed: 19158356
pmcid: 2653687
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150:604–612. https://doi.org/10.7326/0003-4819-150-9-200905050-00006
doi: 10.7326/0003-4819-150-9-200905050-00006
pubmed: 19414839
pmcid: 2763564
Robles JA, Troy JD, Schroeder KM, Martin PL, LeBlanc TW (2021) Parental limited English proficiency in pediatric stem cell transplantation: clinical impact and healthcare utilization. Pediatr Blood Cancer 68:e29174. https://doi.org/10.1002/pbc.29174
doi: 10.1002/pbc.29174
pubmed: 34109732
pmcid: 9100897
Chinnakotla S, Verghese P, Chavers B, Rheault MN, Kirchner V, Dunn T, Kashtan C, Nevins T, Mauer M, Pruett T, MNUM Pediatric Transplant Program (2017) Outcomes and risk factors for graft loss: lessons learned from 1,056 pediatric kidney transplants at the University of Minnesota. J Am Coll Surg 224:473–486. https://doi.org/10.1016/j.jamcollsurg.2016.12.027
doi: 10.1016/j.jamcollsurg.2016.12.027
pubmed: 28254584
Ashoor IF, Dharnidharka VR (2019) Non-immunologic allograft loss in pediatric kidney transplant recipients. Pediatr Nephrol 34:211–222. https://doi.org/10.1007/s00467-018-3908-4
doi: 10.1007/s00467-018-3908-4
pubmed: 29480356
Dobbels F, Ruppar T, De Geest S, Decorte A, Van Damme-Lombaerts R, Fine RN (2010) Adherence to the immunosuppressive regimen in pediatric kidney transplant recipients: a systematic review. Pediatr Transplant 14:603–613. https://doi.org/10.1111/j.1399-3046.2010.01299.x
doi: 10.1111/j.1399-3046.2010.01299.x
pubmed: 20214741
Freeman MA, Myaskovsky L (2015) An overview of disparities and interventions in pediatric kidney transplantation worldwide. Pediatr Nephrol 30:1077–1086. https://doi.org/10.1007/s00467-014-2879-3
doi: 10.1007/s00467-014-2879-3
pubmed: 25315177
Mohamed M, Soliman K, Pullalarevu R, Kamel M, Srinivas T, Taber D, Posadas Salas MA (2021) Non-adherence to appointments is a strong predictor of medication non-adherence and outcomes in kidney transplant recipients. Am J Med Sci 362:381–386. https://doi.org/10.1016/j.amjms.2021.05.011
doi: 10.1016/j.amjms.2021.05.011
pubmed: 34015328
Taber DJ, Fleming JN, Fominaya CE, Gebregziabher M, Hunt KJ, Srinivas TR, Baliga PK, McGillicuddy JW, Egede LE (2017) The impact of health care appointment non-adherence on graft outcomes in kidney transplantation. Am J Nephrol 45:91–98. https://doi.org/10.1159/000453554
doi: 10.1159/000453554
pubmed: 27907919
Dunlap JL, Jaramillo JD, Koppolu R, Wright R, Mendoza F, Bruzoni M (2015) The effects of language concordant care on patient satisfaction and clinical understanding for Hispanic pediatric surgery patients. J Pediatr Surg 50:1586–1589. https://doi.org/10.1016/j.jpedsurg.2014.12.020
doi: 10.1016/j.jpedsurg.2014.12.020
pubmed: 25783324
Schenker Y, Karter AJ, Schillinger D, Warton EM, Alder NE, Moffet HH, Ahmed AT, Fernandez A (2010) The impact of limited English proficiency and physician language concordance on reports of clinical interactions among patients with diabetes: the DISTANCE study. Patient Educ Couns 81:222–228. https://doi.org/10.1016/j.pec.2010.02.005
doi: 10.1016/j.pec.2010.02.005
pubmed: 20223615
pmcid: 2907435
Ortega P, Pérez N, Robles B, Turmelle Y, Acosta D (2019) Teaching medical Spanish to improve population health: evidence for incorporating language education and assessment in U.S. medical schools. Health Equity 3:557–566. https://doi.org/10.1089/heq.2019.0028
doi: 10.1089/heq.2019.0028
pubmed: 31701080
pmcid: 6830530
Patzer RE, Amaral S, Klein M, Kutner N, Perryman JP, Gazmararian JA, McClellan WM (2012) Racial disparities in pediatric access to kidney transplantation: does socioeconomic status play a role? Am J Transplant 12:369–378. https://doi.org/10.1111/j.1600-6143.2011.03888.x
doi: 10.1111/j.1600-6143.2011.03888.x
pubmed: 22226039
pmcid: 3951009
Ortega P, Shin TM, Martínez GA (2021) Rethinking the term “limited English proficiency” to improve language-appropriate healthcare for all. J Immigr Minor Health 24:799–805. https://doi.org/10.1007/s10903-021-01257-w
doi: 10.1007/s10903-021-01257-w
pubmed: 34328602
pmcid: 8323079