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.
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Acknowledgment
This study was funded in part by a Physician Faculty Development in Primary Care Grant (#D55 HP 05165-01-00) from the Department of Health and Human Services. Dr. Bibbins-Domingo’s efforts were supported by the Robert Wood Johnson Foundation (Amos Faculty Development Award) and an NIH National Heart, Lung, and Blood Institute Diversity Supplement. Dr. Fernandez’ efforts were supported by an NIH Career Development Award (K23 832401).
Conflict of Interest
None disclosed.
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Grubbs, V., Bibbins-Domingo, K., Fernandez, A. et al. Acute Myocardial Infarction Length of Stay and Hospital Mortality Are Not Associated with Language Preference. J GEN INTERN MED 23, 190–194 (2008). https://doi.org/10.1007/s11606-007-0459-y
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DOI: https://doi.org/10.1007/s11606-007-0459-y