Journal of General Internal Medicine

, Volume 23, Issue 2, pp 190–194

Acute Myocardial Infarction Length of Stay and Hospital Mortality Are Not Associated with Language Preference

  • Vanessa Grubbs
  • Kirsten Bibbins-Domingo
  • Alicia Fernandez
  • Arpita Chattopadhyay
  • Andrew B. Bindman
Original Article

Abstract

BACKGROUND

Language barriers between patients and providers may influence the process and quality of care.

OBJECTIVE

To examine the association of language preference with length of stay (LOS) and in-hospital mortality for patients admitted for acute myocardial infarction (AMI).

DESIGN, SETTING, AND PARTICIPANTS

Electronic administrative hospital discharge data for all non-disabled Medicaid beneficiaries age 35 years and older admitted to all acute care California hospitals with a diagnosis of AMI between 1994 and 1998.

METHODS

We used multivariate regression to explore whether observed differences in the hospital LOS and in-hospital mortality between non-English preference (NEP) and English preference (EP) individuals could be explained by individual and/or hospital level factors. We adjusted for patient level characteristics using 24 covariates from a previously validated prediction model of mortality after hospitalization for AMI.

RESULTS

Of 12,609 Medicaid patients across 401 California hospitals, 2,757 (22%) had NEP. NEP was associated with a 3.9% increased LOS (95% CI 0.7, 7.1; p = 0.02) in unadjusted analysis and a 3.8% increased LOS (95% CI 0.3, 7.3; p = 0.03) after controlling for patient level characteristics. Differences in LOS were no longer significant after adjusting receipt of cardiac procedure/ surgery (2.8%; 95% CI −0.6, 6.2; p = 0.1) or after adjusting for hospital (0.9%; 95% CI −2.5, 4.3; p = 0.6). Non-English language preference was associated with lower in-hospital mortality in unadjusted analysis (odds ratio [OR] = 0.80; 95% CI 0.69, 0.94; p = 0.005), but was not significant after adjusting for patient level characteristics (adjusted OR [AOR] 0.95; 95% CI 0.78, 1.27; p = 0.6). Adjusting for receipt of cardiac procedure/ surgery (AOR 0.97; 95% CI 0.79, 1.18; p = 0.7) and hospital (AOR 0.97; 95% CI 0.78; 1.21; p = 0.8) did not alter this finding.

CONCLUSIONS

Language preference is not associated with AMI mortality, and the small increase in length of stay associated with non-English preference is accounted for by hospital level factors. Our results suggest that system level differences are important to consider in studies of the effect of language barriers in the health care setting.

KEY WORDS

language preference communication limited English proficient language barrier 

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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Vanessa Grubbs
    • 1
  • Kirsten Bibbins-Domingo
    • 1
    • 2
    • 3
  • Alicia Fernandez
    • 2
  • Arpita Chattopadhyay
    • 2
  • Andrew B. Bindman
    • 2
    • 3
  1. 1.Division of General Internal Medicine, Department of MedicineUniversity of CaliforniaSan FranciscoUSA
  2. 2.Division of General Internal Medicine, San Francisco General Hospital, Department of MedicineUniversity of CaliforniaSan FranciscoUSA
  3. 3.Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoUSA

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