In primarily English speaking settings, when a patient’s language is discordant from the primary language of the region, does language proficiency predict differences in vascular risk, stroke severity, and the DOC comorbidities: Depression, Obstructive Sleep Apnea and Cognitive impairment?

Patients with ischemic stroke or TIA between 2012 - 2018 were consecutively recruited across 8 regional stroke centers. Vascular risk factors and stroke severity (mRS) were collected. A validated DOC screening tool was administered. Participants were grouped into: (1) Primary English Speaking (PES), (2) English as a Second Language (ESL) or (3) Non-English Speaking (NES) requiring translation. Binary logistic regression models with age, gender and education as covariates were employed.

6,556  patients met inclusion criteria for the study. We observed a statistically significant difference of diabetes, dyslipidemia, hypertension frequency across our cohorts, with the lowest in the PES cohort and the greatest in the NES cohort. Controlling for covariates, ESL patients had odds of having diabetes, dyslipidemia, and hypertension, that were 29%, 20%, and 37% increased compared to PES. NES patients also had a 35% and 55% increased odds of having dyslipidemia and hypertension. NES patients had a 66% increased odds of having a severe stroke compared to PES patients. Furthermore, ESL and NES patients had two times greater odds of having lower cognitive scores.

In patients with stroke/TIA, language proficiency may identify increased neurovascular risk and potential for severe stroke. While there was no observed relation to depression or OSA, our results indicate that, even with formal translation, lower cognitive scores must be interpreted with caution.  Language proficiency might reflect unique health literacy and socioeconomic needs, as well as a need to improve health education and prevention across language or cultural barriers.