Illness Severity among Non-English, Non-Spanish Speaking Patients in a Public Emergency Department

Background: Patients with limited English proficiency (LEP) have poor health outcomes compared to English proficient patients. Most studies on language proficiency and health disparities focus on Spanish. Objective: This study examines whether non-Spanish speaking LEP patients experience greater disparities than Spanish speaking LEP patients by comparing disease acuity and language proficiency in an emergency department. Design: This is a retrospective case-control study from November 2010 to February 2012 comparing differences between non-English non-Spanish (NENS) speaking patients to English speaking patients with differences between Spanish speaking and English speaking patients. Main outcomes: Primary endpoints include the emergency severity index (ESI) score, area of triage, days in hospital, and the rates of admission, in-hospital surgery, intensive care unit admission, and all-cause mortality. Results: Among all of the study patients, the average age was 55.1 (+/- 12.4). Comparing the NENS sample to the English sample yielded differences in surgery rates (NENS 11.3%, English 1.9%, p=0.002), admission rates (NENS 38.8%, English 24.7%, p=0.025), and days in hospital (NENS 2.49 +/-5.43, English 1.93+/-8.56, p Conclusions and relevance: We were able to demonstrate greater healthcare needs among NENS patients compared to the other two groups. The NENS patients were more likely to be admitted, have surgery, and stay longer than those speaking English or Spanish. These findings are important because they suggest further research, awareness of these disparities by healthcare providers, and public health interventions focusing on this population are warranted