Exploring the Impact of Limited English Proficiency on Sepsis Mortality Rates

Health care workers trying to overcome the language barrier.

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Effective communication is crucial in delivering quality health care and ensuring positive patient outcomes, particularly for those with limited English proficiency (LEP). Language barriers can pose significant challenges and potentially affect the health of LEP individuals. Study results published today in JAMA Network Open from a retrospective cohort study aimed to investigate the relationship between LEP and inpatient mortality among patients with sepsis, highlighting a frequently ignored aspect of health care disparities.

Sepsis is a critical medical condition characterized by a severe response to infection. It can lead to organ dysfunction, long-term complications, and even death. Prompt diagnosis and appropriate treatment are crucial for sepsis patients. However, several factors beyond the medical condition itself can influence outcomes.

“Limited English proficiency status may lead to worse sepsis outcomes due to communication barriers, lower-quality care, potential biases, and other factors,” wrote the authors. “We aimed to evaluate the association between LEP and inpatient mortality due to sepsis at a hospital representing different languages, races and ethnicities, and geography than the original study. We hypothesized that inpatient mortality due to sepsis would be higher among patients with LEP. Our examination of this association in a new population, with new adjustments for socioeconomic status and illness severity, helps further characterize a potential health inequity affecting over 1 million patients annually and may offer opportunities for focused interventions.

The study, conducted at a prominent New England tertiary care center, delved into the experiences of patients with sepsis who faced language barriers due to limited English proficiency. These language barriers encompassed challenges in conveying symptoms, understanding medical instructions, and effectively participating in their health care decisions.

The authors wrote, "In a study on sepsis patients, limited English proficiency (LEP) didn't show a significant overall mortality link. However, LEP patients in the non-Hispanic White subgroup faced higher mortality rates."

The study analyzed data from electronic medical records from January 1, 2016, to December 31, 2019. Patients included in the study met the CDC's sepsis criteria, received antibiotics within 24 hours, and were admitted through the emergency department. The primary outcome of interest was inpatient mortality.

A total of 2,709 patients met the inclusion criteria for the study. The cohort had a mean age of 65.0 years, with a diverse representation of races and ethnicities. 56.2% were men and 43.8% were women. Among the patients, 12.1% had limited English proficiency. Languages spoken included but were not limited to Spanish, Arabic, Russian, Portuguese, Chinese, and Haitian Creole.

Unadjusted mortality rates revealed that 21.1% of patients with LEP experienced inpatient mortality, compared to 19.6% of patients with English proficiency. However, statistical analysis did not find a significant difference in mortality odds between the 2 groups.

While the findings indicated no significant association between LEP and sepsis mortality, a subgroup analysis painted a more nuanced picture. Among the non-Hispanic White subgroup, patients with LEP faced significantly higher odds of inpatient mortality (adjusted OR, 1.56). In contrast, there were no significant differences in mortality rates between LEP and English proficient individuals in the racial and ethnic minority subgroup.

The authors note that the study's results underscore the importance of considering language barriers in health care, particularly in diverse settings. While the overall findings did not reveal a significant association between LEP and sepsis mortality, the subgroup analysis illuminated a language-based disparity, especially among non-Hispanic White patients.

The authors note that these findings raise important questions about the potential impact of language barriers on health care outcomes and highlight the need for further research. Understanding the drivers of this inequity and its manifestations in other health care systems is crucial for developing equitable care models for patients with limited English proficiency.

“As our cohort study has noted, patients’ language preferences must be respected and integrated into their medical care, regardless of race or ethnicity,” the authors concluded. “We must improve care for patients with LEP and other patients experiencing inequities….”

REFERENCE

Jacobs ZG, Prasad PA, Fang MC, Abe-Jones Y, Kangelaris KN. The Association between limited English proficiency and sepsis mortality. J Hosp Med. 2020 Mar;15(3):140-146. doi: 10.12788/jhm.3334. PMID: 31891556; PMCID: PMC7064297. (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2813600)