Influence of language barriers on outcomes of hospital care for general medicine inpatients

Abstract

Background: Few studies have examined whether patients with language barriers receive worse hospital care in terms of quality or efficiency.

Objective: : To examine whether patients' primary language influences hospital outcomes.

Design and setting: Observational cohort of urban university hospital general medical admissions between July 1, 2001 to June 30, 2003.

Patients: Eighteen years old or older whose hospital data included information on their primary language, specifically English, Russian, Spanish or Chinese.

Measurements: Hospital costs, length of stay (LOS), and odds for 30-day readmission or 30-day mortality.

Results: Of 7023 admitted patients, 84% spoke English, 8% spoke Chinese, 4% Russian and 4% Spanish. In multivariable models, non-English and English speakers had statistically similar total cost, LOS, and odds for mortality. However, non-English speakers had higher adjusted odds of readmission (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.0-1.7). Higher odds for readmission persisted for Chinese and Spanish speakers when compared to all English speakers (OR, 1.7; 95% CI, 1.2-2.3 and OR, 1.5; 95% CI, 1.0-2.3 respectively).

Conclusions: After accounting for socioeconomic variables and comorbidities, non-English speaking Latino and Chinese patients have higher risk for readmission. Whether language barriers produce differences in readmission or are a marker for less access to post-hospital care remains unclear. Journal of Hospital Medicine 2010;5:276-282. (c) 2010 Society of Hospital Medicine.

Trial registration: ClinicalTrials.gov NCT00204048.