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

• Published in: The Journal of surgical research Vol. 280; pp. 326 - 332
• Main Authors: Castro, Maria R.H., Schwartz, Hope, Hernandez, Sophia, Calthorpe, Lucia, Fernández, Alicia, Stein, Deborah, Mackersie, Robert C., Menza, Rebecca, Bongiovanni, Tasce
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2022
• Subjects: Adult; Communication Barriers; Healthcare disparities; Hispanic or Latino; Humans; Language; Limited English Proficiency; Morbidity; Mortality; Retrospective Studies; Trauma; Wounds and Injuries; Limited English proficiency; Healthcare disparities; Language; Trauma; Mortality; Morbidity
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2022.07.044

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. 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). 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). 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.