Abstract
BackgroundLanguage barrier is an important determinant of health care access and health. We examined the associations of English proficiency with type-2 diabetes (T2DM) and diabetic retinopathy (DR) in Asian Indians living in Singapore, an urban city where English is the predominant language of communication.MethodsThis was a population-based, cross-sectional study. T2DM was defined as HbA1c ≥6.5%, use of diabetic medication or a physician diagnosis of diabetes. Retinal photographs were graded for the severity of DR including vision-threatening DR (VTDR). Presenting visual impairment (VI) was defined as LogMAR visual acuity > 0.30 in the better-seeing eye. English proficiency at the time of interview was assessed.ResultsThe analyses included 2,289 (72.1%) English-speaking and 885 (27.9%) Tamil- speaking Indians. Tamil-speaking Indians had significantly higher prevalence of T2DM (46.2 vs. 34.7%, p < 0.001) and, among those with diabetes, higher prevalence of DR (36.0 vs. 30.6%, p < 0.001), VTDR (11.0 vs. 6.5%, p < 0.001), and VI (32.4 vs. 14.6%) than English speaking Indians. Oaxaca decomposition analyses showed that the language-related discrepancies (defined as the difference in prevalence between persons speaking different languages) in T2DM, DR, and VTDR could not be fully explained by socioeconomic measures.ConclusionsIn an English dominant society, Tamil-speaking Indians are more likely to have T2DM and diabetic retinopathy. Social policies and health interventions that address language-related health disparities may help reduce the public health impact of T2DM in societies with heterogeneous populations.
Highlights
Language barrier is an important determinant of health care access and health
People with T2DM have a substantial risk of diabetic retinopathy (DR), which, if left untreated, can lead to vision-threatening diabetic retinopathy (VTDR) and to visual impairment (VI) [2]
Diabetes and diabetic retinopathy assessment Based on American Diabetes Association’s diagnostic criteria, diabetes was defined as a self-reported previous diagnosis of the disease, or a hemoglobin A1c (Hba1c) ≥ 6.5%
Summary
Language barrier is an important determinant of health care access and health. We examined the associations of English proficiency with type-2 diabetes (T2DM) and diabetic retinopathy (DR) in Asian Indians living in Singapore, an urban city where English is the predominant language of communication. Among other social determinants, is known as an important factor predicting poorer health and barrier to care [4,5,6,7,8,9,10]. Language barrier can be measured by a participant’s English proficiency during survey interview [11,12]. English proficiency during the interview is a functional measure determined by interviewers and it is not subject to self-assessment bias [10,11]
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