End-of-Life Acute Care Use and Pain-Related Outcomes in Chinese-speaking Residents in Canadian Long-Term Care Homes

Abstract

Objectives: Patients from ethnically minoritized communities often face disparities in health care due to language and cultural barriers. This study aimed to compare health care use and end-of-life outcomes between Chinese-speaking residents living in language-concordant and language-discordant long-term care (LTC) homes. Design: Retrospective cohort study. Setting and Participants: A total of 69,630 LTC residents who died between January 2017 and December 2019 in Ontario, Canada. Methods: We compared Chinese-speaking residents in ethnic Chinese LTC homes (n = 931) (ie, language-concordant) with Chinese-speaking residents in non-Chinese homes (n = 510) (ie, language discordant), non–Chinese-speaking residents in ethnic Chinese homes (n = 408), and non–Chinese-speaking residents in all other homes (n = 67,781). Primary language spoken by the resident captured in the Resident Assessment Instrument–Minimum Data Set was used to classify residents as Chinese- or non–Chinese-speaking. Ethnic Chinese homes included those formally designated as a Chinese cultural home or where at least 20% of its residents spoke Chinese as their primary language. Main outcomes were hospitalization, emergency department visits, pain management in the last 3 days of life, and location of death. Results: Residents in ethnic Chinese LTC homes, irrespective of their primary language, were significantly more likely to be admitted to hospitals in the last 3 days of life. Similarly, Chinese-speaking residents in all homes and all residents receiving care in ethnic Chinese homes were more likely to die in hospital than non–Chinese-speaking residents in all other homes. Chinese-speaking residents in language-concordant homes were less likely to report frequent and severe pain (odds ratio, 0.3; 95% CI, 0.2–0.7) than non–Chinese-speaking residents in other homes. Conclusions and Implications: Chinese-speaking residents and residents in ethnic Chinese homes were more likely to be hospitalized at the end of life and die in hospitals. However, receiving care in a language-concordant environment was associated with lower odds of reporting frequent and severe pain near the end of life among Chinese-speaking LTC residents.