Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Medical Research Methodology
Published in: BMC Medical Research Methodology 1/2024

Open Access 01-12-2024 | Research

Ascertaining the Francophone population in Ontario: validating the language variable in health data

Authors: Ricardo Batista, Amy T. Hsu, Louise Bouchard, Michael Reaume, Emily Rhodes, Ewa Sucha, Eva Guerin, Denis Prud’homme, Douglas G. Manuel, Peter Tanuseputro

Published in: BMC Medical Research Methodology | Issue 1/2024

Login to get access

Abstract

Background

Language barriers can impact health care and outcomes. Valid and reliable language data is central to studying health inequalities in linguistic minorities. In Canada, language variables are available in administrative health databases; however, the validity of these variables has not been studied. This study assessed concordance between language variables from administrative health databases and language variables from the Canadian Community Health Survey (CCHS) to identify Francophones in Ontario.

Methods

An Ontario combined sample of CCHS cycles from 2000 to 2012 (from participants who consented to link their data) was individually linked to three administrative databases (home care, long-term care [LTC], and mental health admissions). In total, 27,111 respondents had at least one encounter in one of the three databases. Language spoken at home (LOSH) and first official language spoken (FOLS) from CCHS were used as reference standards to assess their concordance with the language variables in administrative health databases, using the Cohen kappa, sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV).

Results

Language variables from home care and LTC databases had the highest agreement with LOSH (kappa = 0.76 [95%CI, 0.735–0.793] and 0.75 [95%CI, 0.70–0.80], respectively) and FOLS (kappa = 0.66 for both). Sensitivity was higher with LOSH as the reference standard (75.5% [95%CI, 71.6–79.0] and 74.2% [95%CI, 67.3–80.1] for home care and LTC, respectively). With FOLS as the reference standard, the language variables in both data sources had modest sensitivity (53.1% [95%CI, 49.8–56.4] and 54.1% [95%CI, 48.3–59.7] in home care and LTC, respectively) but very high specificity (99.8% [95%CI, 99.7–99.9] and 99.6% [95%CI, 99.4–99.8]) and predictive values. The language variable from mental health admissions had poor agreement with all language variables in the CCHS.

Conclusions

Language variables in home care and LTC health databases were most consistent with the language often spoken at home. Studies using language variables from administrative data can use the sensitivity and specificity reported from this study to gauge the level of mis-ascertainment error and the resulting bias.
Appendix
Available only for authorised users
Literature
1.
Bouchard L, Gaboury I, Chomienne M-H, Gilbert A, Dubois L. La santé en situation linguistique minoritaire. Healthc Policy. 2009;4:36–42.PubMedPubMedCentral
2.
3.
Leis A, Bouchard L, Editorial. The Health of Official Language Minority populations. Can J Public Health. 2013;104:2.
4.
Gagnon-Arpin I, Bouchard L, Leis A, Bélanger M. Access to and use of Health Care Services in the Minority Language. In: Landry R, editor. Life in an Official Minority Language in Canada. Moncton, New Brunswick: Canadian Institute for Research on Linguistic Minorities; 2014. pp. 177–98.
5.
Bouchard L, Batista R, Reaume M. Résultats de l’enquête sur la santé dans les collectivités canadiennes. Ottawa, ON: Université d’Ottawa et Institut du savoir Montfort; 2021. p. 32. Évolution de principaux indicateurs de la santé de la population francophone et anglophone de l’Ontario: 2001–2014.
6.
Gaboury I, Noël JG, Forgues É, Bouchard L. Les données administratives et d’enquêtes sur l’état de santé et l’accès aux services des communautés francophones en situation minoritaire: Potentiel D’analyse et état de situation. Ottawa, ON: Consortium national de formation en santé; 2009. p. 44.
7.
Bouchard L, Lizotte M. Les données linguistiques pour la recherche et la planification en santé: possibilités et limites pour l’étude des francophones en situation minoritaire. Minorité Linguistique et Société 2024; sous presse.
8.
Hasnain-Wynia R, Baker DW. Obtaining data on patient race, ethnicity, and primary language in health care organizations: current challenges and proposed solutions. Health Serv Res. 2006;41:1501–18.PubMedPubMedCentralCrossRef
9.
10.
Makvandi E, Bouchard L, Bergeron PJ, Sedigh G. Methodological issues in analyzing small populations using CCHS cycles based on the Official Language Minority studies. Can J Public Health-Revue Canadienne De Sante Publique. 2013;104:S55–9.CrossRef
11.
Tempier R, Bouattane EM, Hirdes JP. Access to psychiatrists by french-speaking patients in Ontario hospitals:2005 to 2013. Healthc Manage Forum. 2015;28:167–71.PubMedCrossRef
12.
Noël JG, Forgues E, Landry R. Qui sont les francophones ? Analyse de définitions selon les variables du recensement. Moncton, NB: Institut canadien de recherche sur les minorités linguistiques, 2014, p. 64.
13.
Statistics Canada. Linguistic characteristics of canadians. 2011 Census of Population. Ottawa, ON: Statistics Canada; 2012. p. 24.
14.
Statistics Canada. English, French and official language minorities in Canada Census in brief. Ottawa, ON: Statistics Canada; 2017. p. 12.
15.
Institute of Medicine. Race, ethnicity, and Language data: standardization for Health Care Quality Improvement. Washington, DC: The National Academy; 2009. p. 287.
16.
Statistics Canada. French and the Francophonie in Canada. Census in brief. Ottawa, ON: Statistics Canada; 2012. p. 13.
17.
Corbeil J-P, Grenier C, Lafrenière S. Minorities speak up: results of the Survey of the vitality of Official-Language minorities. Ottawa, ON: Statistics Canada; 2006. p. 176.
18.
Bourbonnais V. La santé des aînés francophones en situation linguistique minoritaire: État Des lieux en Ontario. Departement De Sociologie, Facultes De Sciences Sociales. Ottawa, ON: University of Ottawa; 2007. p. 126.
19.
Bouchard L, Batal M, Imbeault P, Gagnon-Arpin I, Makandi E, Sedigh G. La santé Des francophones de l’Ontario Un portrait régional tiré des Enquêtes sur la santé dans les collectivités canadiennes (ESCC). Rapports sur la santé des francophones de l’Ontario. Ottawa, ON: Réseau de recherche appliquée sur la santé des francophones de l’Ontario; 2012. p. 75.
20.
Sucha E, SIlva E, Batista R, Bouchard L. Mortality in francophone minority in Canada – A 16-year follow-up study. Mortality by socioeconomic status among Canadian francophones and anglophones living outside Québec. Ottawa, ON: Réseau de recherche appliquée sur la santé des francophones de l’Ontario, University of Ottawa; 2014. p. 16.
21.
Auger N, Harper S, Barry AD, Trempe N, Daniel M. Life expectancy gap between the Francophone majority and anglophone minority of a Canadian population. Eur J Epidemiol. 2012;27:27–38.PubMedCrossRef
22.
23.
Iron K, Manuel D. Quality assessment of administrative data (QuAAD): an opportunity for enhancing Ontario’s health data. Atlases and reports. Ottawa, ON: Institute for Clinical Evaluative Sciences; 2007. p. 35.
24.
Tu K, Wang M, Jaakkimainen RL, et al. Assessing the validity of using administrative data to identify patients with epilepsy. Epilepsia. 2014;55:335–43.PubMedCrossRef
25.
Lix LM, Yogendran MS, Shaw SY, Targownick LE, Jones J, Bataineh O. Comparing administrative and survey data for ascertaining cases of irritable bowel syndrome: a population-based investigation. BMC Health Serv Res. 2010;10:31.PubMedPubMedCentralCrossRef
26.
Muggah E, Graves E, Bennett C, Manuel DG. Ascertainment of chronic diseases using population health data: a comparison of health administrative data and patient self-report. BMC Public Health. 2013;13:16.PubMedPubMedCentralCrossRef
27.
Muhajarine N, Mustard C, Roos LL, Young TK, Gelskey DE. Comparison of survey and physician claims data for detecting hypertension. J Clin Epidemiol. 1997;50:711–8.PubMedCrossRef
28.
Hux JE, Ivis F, Flintoft V, Bica A. Diabetes in Ontario. Determ Preval Incidence Using Validated Administrative data Algorithm. 2002;25:512–6.
29.
Huzel L, Roos LL, Anthonisen NR, Manfreda J. Diagnosing asthma: the fit between survey and administrative database. Can Respir J. 2002;9:407–12.PubMedCrossRef
30.
Lix LM, Yogendran MS, Leslie WD, et al. Using multiple data features improved the validity of osteoporosis case ascertainment from administrative databases. J Clin Epidemiol. 2008;61:1250–60.PubMedCrossRef
31.
Tu K, Campbell NRC, Chen Z-L, Cauch-Dudek KJ, McAlister FA. Accuracy of administrative databases in identifying patients with hypertension. Open Med. 2007;1:e18–26.PubMedPubMedCentral
32.
Bouchard L, Makvandi E, Sedigh G, Van Kemenade S. The Health of the Francophone Population Aged 65 and over in Ontario. A region-by-region portrait based on the Canadian Community Health Survey (CCHS). Ottawa2014, p. 48.
33.
Belanger M, Bouchard L, Gaboury I, et al. Perceived health status of francophones and anglophones in an officially bilingual Canadian province. Can J Public Health = Revue canadienne de sante Publique. 2011;102:122–6.PubMedCrossRef
34.
35.
Watson PF, Petrie A. Method agreement analysis: a review of correct methodology. Theriogenology. 2010;73:1167–79.PubMedCrossRef
36.
Cunningham M. More than just the Kappa Coefficient: a program to fully characterize inter-rater reliability between two raters. SAS Global Forum 2009. Pittsburgh, PA: University of Pittsburgh; 2009. p. 7.
37.
Benchimol EI, Smeeth L, Guttmann A, et al. The REporting of studies conducted using Observational routinely-collected health data (RECORD) Statement. PLoS Med. 2015;12:e1001885.PubMedPubMedCentralCrossRef
38.
Human Rights & Health Equity Office. Guide to Demographic Data Collection in Health-care settings. Toronto, ON: Human Rights & Health Equity Office, Sinai Health System; 2017. p. 30.
39.
Hedges Greising C. Collecting race, ethnicity, and primary Language Data: Tools to Improve Quality of Care and Reduce Health Care disparities. Issue brief. Chicago, IL: Health Reseach and Educational Trust; 2012. p. 6.
40.
Hasnain-Wynia R, Pierce D, Pittman MA. Who, when, and how: the current state of race, ethnicity, and primary Language Data Collection in hospitals. New York, NY: The Commonwealth Fund; 2004. p. 42.
41.
Duong LM, Singh SD, Buchanan N, Phillips JL, Gerlach K. Evaluation of primary/preferred language data collection. J Registry Manag. 2012;39:121–32.PubMed
42.
Ulmer C, McFadden B, Nerenz D. Defining Language need and categories for Collection. In: Ulmer CMB, Nerenz DR, editors. Race, ethnicity, and Language Data: standardization for Health Care Quality Improvement. Washington DC: Institute of Medicine, National Academies; 2009. pp. 93–125.
43.
John-Baptiste A, Naglie G, Tomlinson G, et al. The effect of English language proficiency on length of stay and in-hospital mortality. J Gen Intern Med. 2004;19:221–8.PubMedPubMedCentralCrossRef
44.
Morris J, Fries B, Bernabei R, et al. Resident Assessment Instrument-Home Care (RAI-HC) user’s Manual, Canadian Version. Washington DC: Canadian Institute for Health Information; 2010. p. 176.
45.
Cheng EM, Chen A, Cunningham W. Primary Language and Receipt of Recommended Health Care among hispanics in the United States. J Gen Intern Med. 2007;22:283–8.PubMedPubMedCentralCrossRef
46.
Hines AL, Andrews RM, Moy E, Barrett ML, Coffey RM. Disparities in Rates of Inpatient Mortality and adverse events: Race/Ethnicity and Language as Independent contributors. Int J Environ Res Public Health. 2014;11:13017–34.PubMedPubMedCentralCrossRef
47.
Karliner LS, Kim SE, Meltzer DO, Auerbach AD, Auerbach AD. Influence of language barriers on outcomes of hospital care for general medicine inpatients. J Hosp Med. 2010;5:276–82.PubMedCrossRef
48.
Bélanger R, Mayer-Crittenden C, Mainguy J, Coutu A. Enquête sur l’offre active pour les services auxiliaires de santé du Nord-Est De l’Ontario. Reflets. 2018;24:212–47.CrossRef
49.
Forgues É, Landry R. L’accès aux services de santé en français et leur utilisation en contexte francophone minoritaire. Moncton, NB: Société Santé en français et Institut canadien de recherche sur les minorités linguistiques, 2014, p.158.
50.
Statistics Canada. L’évolution Du Bilinguisme français-anglais Au Canada De 1901 à 2011. Ottawa, ON: Statistics Canada; 2012. p. 5.
51.
Klinger EV, Carlini SV, Gonzalez I, et al. Accuracy of race, ethnicity, and language preference in an electronic health record. J Gen Intern Med. 2015;30:719–23.PubMedCrossRef
52.
Metadata
Title
Ascertaining the Francophone population in Ontario: validating the language variable in health data
Authors
Ricardo Batista
Amy T. Hsu
Louise Bouchard
Michael Reaume
Emily Rhodes
Ewa Sucha
Eva Guerin
Denis Prud’homme
Douglas G. Manuel
Peter Tanuseputro
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Medical Research Methodology / Issue 1/2024
Electronic ISSN: 1471-2288
DOI
https://doi.org/10.1186/s12874-024-02220-7

Other articles of this Issue 1/2024

BMC Medical Research Methodology 1/2024 Go to the issue

Research

A time series driven model for early sepsis prediction based on transformer module

Research

Identification of difficult laryngoscopy using an optimized hybrid architecture

Research

Smoothed quantile residual life regression analysis with application to the Korea HIV/AIDS cohort study

Research

Using the Super Learner algorithm to predict risk of major adverse cardiovascular events after percutaneous coronary intervention in patients with myocardial infarction

Research

Evaluation of respondent-driven sampling in seven studies of people who use drugs from rural populations: findings from the Rural Opioid Initiative

Research

The establishment of a multiple myeloma clinical registry in the Asia–Pacific region: The Asia–Pacific Myeloma and Related Diseases Registry (APAC MRDR)