June 2008

Language Barriers Add Risk for Hypertension Among Chinese Americans

Diana Lau, R.N., M.S., C.N.S
Administrative Director
UCSF Asian Heart and Vascular Center

Cardiovascular disease and stroke are among the top three leading causes of death among Asian Americans. In San Francisco, Asian Americans make up about a third of the city's population. Despite the high incidence of heart disease and stroke in this large population, few data exist on the incidence or prevalence of hypertension — a major risk factor for stroke, heart attack and heart failure.

A research study conducted in 2000 found that a specific subset of San Francisco's Chinese population had a high prevalence of hypertension and a much lower rate of blood pressure (BP) control compared to the general U.S. population. Sixty-nine percent of the Chinese adults in San Francisco suffered from hypertension compared to 29 percent of adults nationwide. The study included 708 Chinese adults residing in San Francisco aged 19 to 98 years old who participated in a blood pressure screening during the city's Chinatown Night Fair.

Despite an alarmingly high incidence of hypertension in this group, only 41 percent took antihypertensive medications to treat their condition. Overall, only 28 patients — 6 percent of all hypertensive patients and 14 percent of those taking antihypertensive medication — attained BP control. In the general U.S. population, use of antihypertensive medication is 59 percent and BP control is achieved in 31 percent on average.

In a separate qualitative study that is still in progress, preliminary findings indicate that cultural and language barriers, low health literacy, economic difficulties, inadequate understanding of medications used, limited health access and lack of health insurance are major factors contributing to the low frequency of antihypertensive medication use and BP control in San Francisco's Chinese-American community. These findings suggest that better health education provided by culturally sensitive bilingual providers is urgently needed to reduce the high incidence of untreated hypertension in this population.

California Senate Bill 853

In response to medical evidence showing that language barriers are a significant contributor to health disparities in ethnic populations, patient and language advocacy groups in California successfully secured the passing of Senate Bill 853, mandating that all health care plans provide language assistance services to their enrollees with limited English proficiency to alleviate language and cultural barriers. The legislation stipulates that all vital documents must be translated into the appropriate language and interpreter services must be available to patients.

By July 1, 2008, every health care service plan must file an amendment to its quality assurance program providing evidence of its written language assistance program policies and procedures. By Jan. 1, 2009, every plan must establish and implement a language assistance program in compliance with the requirements.

All health care providers should be aware of SB 853 to ensure that patients with limited English proficiency receive language assistance when necessary so that their quality of health care is not jeopardized.

The state Department of Managed Health Care (DMHC) periodically reviews the language assistance programs of health care plan providers to evaluate compliance with cultural competency.

UCSF Asian Heart and Vascular Center

The UCSF Asian Heart and Vascular Center (AHVC) serves San Francisco's Asian community, the fastest-growing segment of the city's population. As this group increases, so does the need for cardiovascular specialists who can appropriately understand, communicate and treat heart disease among Asian Americans.

To improve communication between doctors and patients, AHVC has an all-Asian staff that is fluent in languages and dialects including Cantonese, Mandarin, Vietnamese, Korean and Japanese. Experts work closely with UCSF interpreters when necessary.

Primary care doctors and specialists can refer patients to the AHVC, which is respectful of cultural differences and aware of the specific cardiovascular needs that distinguish the Asian population.

Services provided by the center include:

  • Top quality heart and vascular care tailored to the Asian community and communicated in the patient's preferred language
  • Access to state-of-the-art technology offered in collaboration with the UCSF Heart and Vascular Center
  • Language-appropriate outpatient education on heart disease — what it is, what patients can do if they suffer from it and how to prevent the condition through lifestyle changes such as altering diet, smoking cessation and increasing physical activity
  • Opportunities to take part in research studies that will help future generations of Asian Americans