Study: Language barriers raise sepsis death risk despite faster treatment

Editor's Note

Patients hospitalized with sepsis who have limited English proficiency (LEP) face significantly higher odds of dying in the hospital even after accounting for multiple demographic and clinical factors, according to research presented at the American Thoracic Society International Conference by researchers from UC San Diego. Healio reported the news June 13.

As detailed in the article, the retrospective cohort study analyzed data from 3,640 adult sepsis patients treated at two tertiary academic hospitals between January 2021 and April 2023. Of those, 688 had LEP, identified by self-reported language and interpreter use. LEP patients had a 41% greater adjusted odds of in-hospital mortality than English-proficient patients (OR = 1.41; P = .04359).

The LEP group had a distinct demographic profile. A majority (68.45%) were Hispanic/Latino, while 80.14% of English-proficient patients were not. Compared with English-proficient patients, those with LEP included more Asian (16.57% vs 6.94%) and mixed/other-race individuals (68.6% vs 19%) and fewer white (12.5% vs 59.35%) and Black (1.02% vs 12.26%) patients. Insurance coverage also differed, with more LEP patients on Medicaid and Medicare and fewer with commercial insurance.

According to the outlet, LEP patients had higher rates of liver disease, diabetes (both general and poorly controlled), solid tumors, and lymphoma. COPD and HIV/AIDS were more common in the English-proficient group.

In univariate analysis, LEP patients received antibiotics more quickly (2.95 vs 3.28 hours; P = .001168), but still had higher in-hospital mortality (21.8% vs 18.02%; P = .02562) and fewer ICU-free days. They were also less likely to receive ventilatory support. However, no significant differences were found in hospital-free days, SOFA scores, vasopressor use, or sepsis protocol compliance.

Lead author Julia Weston, MD, told Healio that the reasons behind these disparities may lie in communication breakdowns and cultural factors. Despite receiving antibiotics sooner, LEP patients may present sicker or receive more aggressive early treatment due to uncertainty, she suggested.

Other details in the full report include the importance of high-quality interpreter services and Dr Weston’s plans for future research.