Study Finds No Link Between Limited English Proficiency and Increased Risk of Mortality

Patients with limited English proficiency have known limitations accessing health care in the United States, including access to hospital care, but those limitations don’t appear to increase the risk of mortality, according to an AHRQ-funded study. “Disparities in Rates of Inpatient Mortality and Adverse Events: Race/Ethnicity and Language as Independent Contributors”appeared December 12, 2014, in the International Journal of Environmental Research and Public Health. Authors of the study, the largest study of language and inpatient mortality and obstetric trauma among hospital patients to date, include AHRQ’s Ernest Moy, M.D., and former AHRQ staff member Roxanne Andrews, Ph.D. Researchers examined rates of inpatient mortality and obstetric trauma across language groups—English, Spanish and languages of Asia and the Pacific Islands—and compared patterns of variation in quality of care by language with patterns by race and ethnicity. Most outcomes were similar, with the exception of higher stroke mortality for Japanese-speaking patients and higher rates of obstetric trauma among patients who did not speak English. Using 2009 data from AHRQ’s Healthcare Cost and Utilization Project, researchers examined nearly 3.8 million California inpatient records.

2014 Dec;11(12):13017-34.

Disparities in rates of inpatient mortality and adverse events: race/ethnicity and language as independent contributors.

Hines AL1, Andrews RM, Moy E, Barrett M, Coffey RM.

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Abstract

Patients with limited English proficiency have known limitations accessing health care, but differences in hospital outcomes once access is obtained are unknown.We investigate inpatient mortality rates and obstetric trauma for self-reported speakers of English, Spanish, and languages of Asia and the Pacific Islands (API) and compare quality of care by language with patterns by race/ethnicity. Data were from the United States Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project,2009 State Inpatient Databases for California. There were 3,757,218 records. Speaking a non-English principal language and having a non-White race/ethnicity did not place patients at higher risk for inpatient mortality; the exception was significantly higher stroke mortality for Japanese-speaking patients. Patients who spoke API languages or had API race/ethnicity had higher risk for obstetric trauma than English-speaking White patients.Spanish-speaking Hispanic patients had more obstetric trauma than English-speaking Hispanic patients. The influence of language on obstetric trauma and the potential effects of interpretation services on inpatient care are discussed. The broader context of policy implications for collection and reporting of language data is also presented. Results from other countries with and without English as a primary language are needed for the broadest interpretation and generalization of outcomes.