Limited English Proficiency Is Associated With Diabetic Retinopathy in Patients Presenting for Cataract Surgery

Abstract

Purpose To investigate the relationship between limited English proficiency (LEP) and diabetic retinopathy (DR) in patients presenting for cataract surgery. Methods This is a retrospective observational study of patients who underwent cataract surgery between January 2014 and February 2020. Patients who self-identified as needing or preferring an interpreter were defined as having LEP. Differences in demographics, characteristics, and outcomes including history of type 2 diabetes (T2DM), DR, preoperative best corrected visual acuity (BCVA), macular edema, and anti-vascular endothelial growth factor injections were analyzed. Statistical comparisons were assessed using logistic regression with generalized estimating equations. Results We included 13,590 eyes. Of these, 868 (6.4%) were from LEP patients. Patients with LEP were more likely to be Hispanic ( P < 0.001), female sex ( P = 0.008), or older age ( P = 0.003) and have worse mean BCVA at presentation ( P < 0.001). Patients with LEP had a significantly higher rate of T2DM ( P < 0.001), macular edema ( P = 0.033), and DR (18.1% vs. 5.8%, P < 0.001). Findings remained significant when controlling for age, sex, race/ethnicity, and type of health insurance. Patients with LEP and DR were more likely to have had later stages of DR ( P = 0.023). Conclusions Patients with LEP presenting for cataract surgery had a higher rate of DR and associated complications compared to patients with English proficiency. Further studies are needed to understand how language disparities influence health and what measures could be taken to improve healthcare in this vulnerable population Translational Relevance Our study highlights healthcare disparities within ophthalmology and emphasizes the importance of advocating for improved healthcare delivery for patients with LEP.

Association between English Proficiency and Kidney Disease Knowledge and Communication Quality among Patients with ESKD

“…[4][5][6] Among adults, LEP status is associated with worse outcomes for individuals with chronic health conditions such as diabetes and heart failure. [7][8][9][10] Although multifactorial, one likely contributor is suboptimal communication about those conditions between LEP patients and their provider teams. [11][12][13][14] There are also well-documented disparities in access to care, adherence to preventive services, and receipt of high quality primary care by LEP status.…”