The Impact of Patients' Primary Language on Inpatient Gastrointestinal Bleeding Outcomes

Abstract

Background: The impact of English proficiency on gastrointestinal bleeding (GIB) outcomes remains unclear. In this analysis, we compare inpatient GIB outcomes between patients with English as their primary language (EPL) and those with a primary language other than English (PLOE). Methods: Using the 2019 State Inpatient Datasets for New Jersey, Maryland, and Michigan states, we created an analysis cohort of GIB hospitalizations using ICD-10 codes. Patients were stratified by primary language (EPL vs. PLOE) and type of bleeding [variceal upper GI bleeding (VUGIB), nonvariceal (NVUGIB) and lower GI bleeding (LGIB)]. Regression analyses were used to compare mortality, 30-day readmissions, and length of stay. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were reported. P<0.05 was considered statistically significant. Results: In the cohort, 5.5-10% spoke a primary language other than English. Endoscopy utilization was lower among patients with PLOE vs. EPL for NVUGIB (17.2% vs. 21.2%, p< 0.001) and LGIB (26.3% vs. 29.2%, p= 0.027). Patients with PLOE had higher odds of dying for VUGIB (aOR 1.45, 95% CI 1.16-2.48) and LGIB (aOR 1.71, 95% CI 1.22-2.12). Patients with PLOE were also more likely to be readmitted after NVUGIB (aOR 1.75, 95% CI 1.64-1.81). However, after controlling for the percentage of PLOE patients discharged from each hospital, the disparities in mortality and readmissions were no longer detected. Conclusion: Disparities exist in GIB outcomes among patients with PLOE but these gaps narrow at hospitals with higher percentages of PLOE patients. Cultural and linguistic competence may improve outcomes in this vulnerable group.