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Honeycutt CC, Bueno KM, Tran T, Gao M, Balu S, Sendak M. Assessment of Spanish Translation of Websites at Top-Ranked US Hospitals. JAMA Netw Open. 2021;4(2):e2037196. doi:10.1001/jamanetworkopen.2020.37196
Coronavirus disease 2019 (COVID-19) has disproportionately affected Latinx communities across the United States. Latinx and African American individuals have 3 times the infection rate and twice the mortality rate from COVID-19 compared with White individuals.1 Latinx individuals are overrepresented as essential workers, which has contributed to their increased risk of contracting COVID-19 and experiencing related complications.2 Additional factors likely contribute to poor Latinx health outcomes, including institutional racism, discrimination, health care access, and socioeconomic and documentation status.3 As of 2019, the US population is 16.9% Latinx, of which 16.1% speak Spanish and do not speak English well.4 Many hospitals have implemented programs to improve accessibility of services to diverse populations. However, translation continues to be inadequate in addressing language barriers preventing Latinx communities from seeking appropriate care.5 Particularly, patients are deprived of important information about hospitals due to a paucity of Spanish translation of hospital websites. Our cross-sectional study aims to elucidate this issue by investigating potential variables associated with Spanish translation of hospital websites.
This cross-sectional study did not involve human participants and, therefore, did not require ethical review under 45 CFR part 46. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.
A list of 30 top adult hospitals and 10 top children’s hospitals in the US was compiled from the US News Weekly & World Report and Newsweek. This list represents a snapshot of US health care, which consists of 637 total health systems, of which 54 contain at least one children’s hospital.6 Hospitals were classified as affiliated or not affiliated with a public medical school. Hospital websites were reviewed between June 29 and August 3, 2020. Websites were assessed for containing policies on Immigration and Customs Enforcement (ICE) activities on hospital grounds. The dependent variable was whether or not hospital websites had real-time Spanish translation capabilities, further categorized as using Google Translate or other translation methods. The 2018 American Community Survey Demographic and Housing Estimates were used to determine percentage of Latinx population in hospital counties. A threshold of P < .05 in logistic regression was used to determine statistical significance of variables on the binary outcome of a hospital website being available in Spanish. Odds ratios were calculated by exponentiating the coefficients of the logistic regression. Statistical analysis was performed using R statistical software version 1.2.5033 (R Project for Statistical Computing) from July to September 2020.
Of the 40 hospitals studied, nine (22.5%) had Spanish translation capabilities. Of those, 2 used Google Translate, whereas translation methods of the others are unknown. No hospital had explicit documentation of human translation of the website into Spanish. Table 1 displays analysis of the variables, including percentage of total hospitals, logistic regression coefficient, and odds ratio. Hospitals with public information about ICE enforcement were significantly more likely to have websites with Spanish translation (logistic regression coefficient, 2.41; odds ratio = 11.16 [95% CI, 1.30 to 127.13]; P = .03). Hospitals affiliated with a public medical school, children’s hospitals, and hospitals with a higher percentage of local Latinx population were not more likely to have websites with Spanish translation. Table 2 includes hospital names and raw data collected in this analysis.
We found that only 22.5% of top hospitals in the United States have websites with Spanish translation. This study highlights the substantial and persistent language barriers that Latinx communities face when accessing health care at hospitals. We found that ICE enforcement information was significantly associated with Spanish translation of hospital websites. Location in a county with more Latinx residents was not associated with Spanish translation.
We acknowledge substantial limitations of this study, including the small sample size and small number of analyzed variables. In the era of COVID-19, when health disparities based on race, ethnicity, and socioeconomic status have come into greater focus, it is critical for hospitals to provide equitable access to care to their entire patient populations. This can begin with the simple act of translating websites.
Accepted for Publication: December 16, 2020.
Published: February 11, 2021. doi:10.1001/jamanetworkopen.2020.37196
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Honeycutt CC et al. JAMA Network Open.
Corresponding Author: Mark Sendak, MD, MPP, Population Health & Data Science Lead, Duke Institute for Health Innovation, 200 Morris St, Durham, NC 27701 (email@example.com).
Author Contributions: Mr Honeycutt had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Honeycutt, Balu, Sendak.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Honeycutt, Moreno Bueno, Tran, Sendak.
Critical revision of the manuscript for important intellectual content: Honeycutt, Moreno Bueno, Gao, Balu, Sendak.
Statistical analysis: Honeycutt, Gao, Sendak.
Obtained funding: Balu, Sendak.
Administrative, technical, or material support: Honeycutt, Moreno Bueno, Balu, Sendak.
Supervision: Honeycutt, Sendak.
Conflict of Interest Disclosures: Dr Sendak reported being the inventor of intellectual property licensed from Duke for both Cohere Med and Clinetic outside the submitted work. No other disclosures were reported.