The Association of Limited English Proficiency With Morbidity and Mortality After Trauma

Maria R H Castro; Hope Schwartz; Sophia Hernandez; Lucia Calthorpe; Alicia Fernández; Deborah Stein; Robert C Mackersie; Rebecca Menza; Tasce Bongiovanni

doi:10.1016/j.jss.2022.07.044

The Association of Limited English Proficiency With Morbidity and Mortality After Trauma

J Surg Res. 2022 Dec:280:326-332. doi: 10.1016/j.jss.2022.07.044. Epub 2022 Aug 26.

Authors

Maria R H Castro¹, Hope Schwartz², Sophia Hernandez³, Lucia Calthorpe², Alicia Fernández⁴, Deborah Stein⁵, Robert C Mackersie⁶, Rebecca Menza⁷, Tasce Bongiovanni⁸

Affiliations

¹ School of Medicine, University of California San Francisco, San Francisco, California. Electronic address: Maria.castro3@ucsf.edu.
² School of Medicine, University of California San Francisco, San Francisco, California.
³ Department of Surgery, University of California San Francisco, San Francisco, California.
⁴ Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.
⁵ Department of Surgery, University of Maryland, Baltimore, Maryland.
⁶ Department of Surgery, University of California San Francisco, San Francisco, California; Department of Surgery, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.
⁷ Department of Surgery, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California; Department of Physiological Nursing, University of California San Francisco, San Francisco, California.
⁸ Department of Surgery, University of California San Francisco, San Francisco, California; Department of Physiological Nursing, University of California San Francisco, San Francisco, California.

PMID: 36030609
DOI: 10.1016/j.jss.2022.07.044

Abstract

Introduction: Disparities following traumatic injury by race/ethnicity and insurance status are well-documented. However, the relationship between limited English proficiency (LEP) and outcomes after trauma is poorly understood. This study describes the association between LEP and morbidity and mortality after traumatic injury.

Methods: A retrospective cohort study was conducted of adult trauma patients admitted to a level 1 trauma center from 2012 to 2018. Morbidity (length of stay [LOS], intensive care unit admission, intensive care unit LOS, discharge destination) and in-hospital mortality for LEP and English proficient (EP) patients were compared using univariate and multivariable logistic and generalized linear models controlling for patient demographics (age, sex, race/ethnicity, insurance) and clinical characteristics (mechanism, activation level, Glasgow Coma Scale, Injury Severity Score, traumatic brain injury).

Results: Of the 13,104 patients, 16% were LEP patients. LEP languages included Chinese (44%) and Spanish (38%), and 18% categorized as "Other," including 33 languages. In multivariable models, LEP was statistically significantly associated with increased hospital LOS (P = 0.003) and increased discharge to home with home health services (P = 0.042) or to skilled nursing facility/rehabilitation (P = 0.006). Mortality rate was 7% for LEP versus 4% for EP patients (P < 0.0001). In multivariable analysis, speaking an LEP language other than Chinese or Spanish was statistically significantly associated with increased mortality compared to EP (P = 0.006).

Conclusions: Following traumatic injury, LEP patients experience increased hospital LOS and are more frequently discharged to home with home health services or to skilled nursing facilities/rehabilitation. LEP patients speaking languages other than Chinese or Spanish experience increased mortality compared to EP patients.

Keywords: Healthcare disparities; Language; Limited English proficiency; Morbidity; Mortality; Trauma.

Publication types

Research Support, U.S. Gov't, P.H.S.

MeSH terms

Adult
Communication Barriers*
Hispanic or Latino
Humans
Limited English Proficiency*
Morbidity
Retrospective Studies
Wounds and Injuries

Grants and funding

K12 HS026383/HS/AHRQ HHS/United States