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The association between primary language spoken and all-cause mortality in critically ill patients.
J Crit Care. 2013 Dec; 28(6):928-34.JC

Abstract

PURPOSE

The study objective was to investigate the association between primary language spoken and all-cause mortality in critically ill patients.

MATERIALS AND METHODS

We performed a cohort study on 48 581 patients 18 years or older who received critical care between 1997 and 2007 in 2 Boston hospitals. The exposure of interest was primary language spoken determined by the patient or family members who interacted with administrative staff during hospital registration. The primary outcome was 30-day mortality. Associations between language and mortality were estimated by bivariable and multivariable logistic regression models with inclusion of covariate terms thought to plausibly interact with both language and mortality. Adjustment included age, race, sex, Deyo-Charlson index, patient type (medical vs surgical), sepsis, creatinine, hematocrit, white blood count, and number of organs with acute failure.

RESULTS

Validation showed that primary language spoken was highly accurate for a statement in the medical record noting the language spoken that matched the assigned language. Patients whose primary language spoken was not English had improved outcomes (odds ratio 30-day mortality, 0.69 [95% confidence interval, 0.60-0.81; P < .001), relative to patients with English as the primary language spoken, fully adjusted. Similar significant associations are seen with death by days 90 and 365 as well as in-hospital mortality. The improved survival in patients with a non-English primary language spoken is not confounded by indicators of severity of disease and is independent of the specific language spoken and neighborhood poverty rate, a proxy for socioeconomic status. There are significant limitations inherent to large database studies that we have acknowledged and addressed with controlling for measured confounding and evaluation of effect modification.

CONCLUSIONS

In a regional cohort, not speaking English as a primary language is associated with improved outcomes after critical care. Our observations may have clinical relevance and illustrate the intersection of several factors in critical illness outcome including severity of illness, comorbidity, and social and economic factors.

Authors+Show Affiliations

Renal Division, Brigham and Women's Hospital, Boston, MA 02115, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

24011755

Citation

Mendu, Mallika L., et al. "The Association Between Primary Language Spoken and All-cause Mortality in Critically Ill Patients." Journal of Critical Care, vol. 28, no. 6, 2013, pp. 928-34.
Mendu ML, Zager S, Moromizato T, et al. The association between primary language spoken and all-cause mortality in critically ill patients. J Crit Care. 2013;28(6):928-34.
Mendu, M. L., Zager, S., Moromizato, T., McKane, C. K., Gibbons, F. K., & Christopher, K. B. (2013). The association between primary language spoken and all-cause mortality in critically ill patients. Journal of Critical Care, 28(6), 928-34. https://doi.org/10.1016/j.jcrc.2013.07.057
Mendu ML, et al. The Association Between Primary Language Spoken and All-cause Mortality in Critically Ill Patients. J Crit Care. 2013;28(6):928-34. PubMed PMID: 24011755.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The association between primary language spoken and all-cause mortality in critically ill patients. AU - Mendu,Mallika L, AU - Zager,Sam, AU - Moromizato,Takuhiro, AU - McKane,Caitlin K, AU - Gibbons,Fiona K, AU - Christopher,Kenneth B, Y1 - 2013/09/05/ PY - 2013/05/23/received PY - 2013/07/13/revised PY - 2013/07/22/accepted PY - 2013/9/10/entrez PY - 2013/9/10/pubmed PY - 2014/7/22/medline KW - Intensive care KW - Language KW - Language discordance KW - Language proficiency KW - Mortality SP - 928 EP - 34 JF - Journal of critical care JO - J Crit Care VL - 28 IS - 6 N2 - PURPOSE: The study objective was to investigate the association between primary language spoken and all-cause mortality in critically ill patients. MATERIALS AND METHODS: We performed a cohort study on 48 581 patients 18 years or older who received critical care between 1997 and 2007 in 2 Boston hospitals. The exposure of interest was primary language spoken determined by the patient or family members who interacted with administrative staff during hospital registration. The primary outcome was 30-day mortality. Associations between language and mortality were estimated by bivariable and multivariable logistic regression models with inclusion of covariate terms thought to plausibly interact with both language and mortality. Adjustment included age, race, sex, Deyo-Charlson index, patient type (medical vs surgical), sepsis, creatinine, hematocrit, white blood count, and number of organs with acute failure. RESULTS: Validation showed that primary language spoken was highly accurate for a statement in the medical record noting the language spoken that matched the assigned language. Patients whose primary language spoken was not English had improved outcomes (odds ratio 30-day mortality, 0.69 [95% confidence interval, 0.60-0.81; P < .001), relative to patients with English as the primary language spoken, fully adjusted. Similar significant associations are seen with death by days 90 and 365 as well as in-hospital mortality. The improved survival in patients with a non-English primary language spoken is not confounded by indicators of severity of disease and is independent of the specific language spoken and neighborhood poverty rate, a proxy for socioeconomic status. There are significant limitations inherent to large database studies that we have acknowledged and addressed with controlling for measured confounding and evaluation of effect modification. CONCLUSIONS: In a regional cohort, not speaking English as a primary language is associated with improved outcomes after critical care. Our observations may have clinical relevance and illustrate the intersection of several factors in critical illness outcome including severity of illness, comorbidity, and social and economic factors. SN - 1557-8615 UR - https://www.unboundmedicine.com/medline/citation/24011755/The_association_between_primary_language_spoken_and_all_cause_mortality_in_critically_ill_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-9441(13)00255-4 DB - PRIME DP - Unbound Medicine ER -