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



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


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


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.


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.


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.


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.


language preference communication limited English proficient language barrier 


  1. 1.
    U.S. Census Bureau. QT-02. Profile of Selected Social Characteristics, 2000.Google Scholar
  2. 2.
    Brach C, Fraser I. Reducing disparities through culturally competent health care: an analysis of the business case. Qual Manag Health Care. 2002;10(4):15–28.PubMedGoogle Scholar
  3. 3.
    Derose KP, Baker DW. Limited English proficiency and Latinos’ use of physician services. Med Care Res Rev. 2000;57(1):76–91.PubMedCrossRefGoogle Scholar
  4. 4.
    Solis JM, et al. Acculturation, access to care, and use of preventive services by Hispanics: findings from HHANES 1982–84. Am J Public Health. 1990;80(Suppl):11–9.PubMedGoogle Scholar
  5. 5.
    Stein JA, Fox SA. Language preference as an indicator of mammography use among Hispanic women. J Natl Cancer Inst. 1990;82(21):1715–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Wagner TH, Guendelman S. Healthcare utilization among Hispanics: findings from the 1994 Minority Health Survey. Am J Manag Care. 2000;6(3):355–64.PubMedGoogle Scholar
  7. 7.
    Woloshin S, et al. Is language a barrier to the use of preventive services? J Gen Intern Med. 1997;12(8):472–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Fiscella K, Franks P, Doescher MP, Saver BG. Disparities in health care by race, ethnicity, and language among the insured. Med Care. 2002;40:52–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Ghandi TK, Burstin HR, Cook EF, et al. Drug complications in outpatients. J Gen Intern Med. 2000;15:149–54.CrossRefGoogle Scholar
  10. 10.
    Crane JA. Patient comprehension of doctor-patient communication on discharge from the emergency department. J Emerg Med. 1997;15:1–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Carrasquillo O, Orav EJ, Brennan TA, Burstin HR. Impact of language barriers on patient satisfaction in an emergency department. J Gen Intern Med. 1999;14:82–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Drennan G. Counting the costs of language services in psychiatry. S Afr Med J. 1996;86:344–5.Google Scholar
  13. 13.
    Vasquez C, Javier R. The problem with interpreters: communicating with Spanish-speaking patients. Hospital & Community Psychiatry. 1991;42:163–5.Google Scholar
  14. 14.
    Chan A, Woodruff RK. Comparison of palliative care needs of English- and non-English-speaking patients. J Palliat Care. 1999;15:26–30.PubMedGoogle Scholar
  15. 15.
    Devore JS, Koskela K. The language barrier in obstetric anesthesia. Am J Obstet Gynecol. 1980;137:745–6.PubMedGoogle Scholar
  16. 16.
    John-Baptiste A, Nagile 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.PubMedCrossRefGoogle Scholar
  17. 17.
    Office of Statewide Health Planning and Development. Errors and Acceptance of California Patient Discharge Data Reporting Manual, 3rd Edition. Sacramento, CA: Office of Statewide Health Planning and Development, 2000.Google Scholar
  18. 18.
    Health Care and Analysis Division. Report on Heart Attack Outcomes in California 1996-1998, Volume 2: Technical Guide, Sacramento, California: California Office of Statewide Planning and Development, February 2002.Google Scholar
  19. 19.
    Bach PB, Pham HH, Schrag D, et al. Primary care physicians who treat blacks and whites. N Engl J Med. 2004;351:575–84.PubMedCrossRefGoogle Scholar

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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