Linguistic Disparities in Spirometry Quality

Background: Patients experiencing language discordance with health care providers have been reported to face barriers to health care access as well as delays in diagnoses and treatment of medical conditions. Diagnosing and treating pulmonary conditions often requires reliable spirometry results whose quality is dependent on real-time communication between patients and technicians. We hypothesized that language discordance would hinder this communication, thereby negatively impacting spirometry test quality. Methods: This was a retrospective cohort study of all adult patients who underwent spirometry testing at a single center pulmonary function lab between April 2022 and March 2023. FEV 1 and FVC results and their corresponding American Thoracic Society and European Respiratory Society quality grades, A through F, were obtained along with data on patient demographics, comorbidities, and medications. The primary predictor of interest was language preference stratified by English language preference (ELP) or non-English language preference (NELP) for communication. Multivariable logistic regression analysis was used to determine if NELP was predictive of low-quality testing after adjusting for potential confounding variables. Results: A total of 1,496 spirometry tests were included in the study, of which 281 (19%) were obtained in subjects with NELP. Low-quality testing for either FEV 1 or FVC was noted in 365 (24%) tests. In multivariable analysis, NELP was associated with increased odds of low-quality FEV 1 (adjusted OR 2.85, 95% CI 2.08–3.89, P < .001) and FVC (adjusted OR 3.38, 95% CI 2.48–4.61, P < .001). Technician experience <12 months and older subject age were also associated with low-quality spirometry. Conclusions: Patients with NELP experiencing language discordance with technicians had increased odds of low-quality spirometry compared with those with ELP. Our findings support a potential role for targeted technician and interpreter training in improving spirometry quality in this population.