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Disparities in Surgical Oncologic Care

E146: Patients with Non-English Primary Language and Cancer Have Fewer Complications and Readmissions When Cared For at Language Serving Hospitals

ePoster Abstract Author(s)

Brittany M. Dacier, MD, MPH (she/her/hers)

Post-Doctoral Research Fellow
Brigham and Women's Hospital
Boston, Massachusetts, United States

Submitter(s)

Brittany M. Dacier, MD, MPH (she/her/hers)

Post-Doctoral Research Fellow
Brigham and Women's Hospital
Boston, Massachusetts, United States

Author(s)

Brittany M. Dacier, MD, MPH (she/her/hers)

Post-Doctoral Research Fellow
Brigham and Women's Hospital
Boston, Massachusetts, United States
AJ

Alyssa N. Jones, MPH

Biostatistician
Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, United States
AR

Amina Rahimi, MEd

Medical Student
Harvard Medical School; Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, United States
Ricardo J. Bello, MD, MPH

Surgical Oncology Fellow
Medical College of Wisconsin
Milwaukee, Wisconsin, United States
GP

Gregory L. Peck, DO, MPH, FACS

Associate Professor of Surgery
Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey, United States
RB

Regan W. Bergmark, MD, MPH, FACS, FARS

Assistant Professor of Otolaryngology
Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, United States
Callisia Clarke, MD, MS

Associate Professor
Medical College of Wisconsin
Milwaukee, Wisconsin, United States
SZ

Syed Nabeel Zafar, MD, MPH

Surgical Oncologist
University of Wisconsin School of Medical and Public Health, United States
AP

Andrea L. Pusic, MD, MHS, FACS, FRCSC

Chief, Division of Plastic and Reconstructive Surgery
Department of Plastic Surgery, Harvard Medical School; Patient-Reported Outcomes, Value & Experience (PROVE) Center, Brigham and Women's Hospital, Boston, MA, United States
DB

David W. Bates, MD, MSc

Professor of Medicine
Division of General Internal Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States
George Molina, MD, MPH (he/him/his)

Assistant Professor of Surgery
Department of Surgery, Division of Surgical Oncology, Brigham and Women's Hospital; Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, MA
Cambridge, Massachusetts, United States
GO

Gezzer Ortega, MD, MPH

Assistant Professor of Surgery
Department of Surgery, Harvard Medical School; Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, United States

Introduction: Addressing language access needs can improve health outcomes for patients with cancer and non-English primary language (NEPL). Our aim was to assess outcomes for patients with cancer and NEPL at Language Serving Hospitals (LSH) versus non-LSH.

Methods: Retrospective cohort study of patients with cancer from New Jersey State Inpatient Database (2010-2019) and State Ambulatory Surgery and Services Databases (2010-2018). Patients with breast, colon, rectal, lung, melanoma or thyroid cancer were included and dichotomized into NEPL and English primary language (EPL). Hospitals were categorized as LSH if more than 12.4% (NJ state average for NEPL) of all patients had NEPL. Primary outcome was 7-day readmission. Secondary outcomes were in-hospital complications, mortality, disposition, and length of stay (LOS). Descriptive and multivariable analyses were performed, adjusting for age, sex, race/ethnicity, and insurance type.

Results: We identified 15 LSH and 60 non-LSH, at which there were 400,406 patients with cancer, 16% of whom were cared for at LSH. At LSH, 25.5% of patients with cancer have NEPL (N=16,795), while at non-LSH, 4.5% have NEPL (N=15,055). Among NEPL patients at LSH, 47.2% were Hispanic compared to 43.0% at non-LSH. At LSH, compared to EPL patients, a lower proportion of NEPL patients were readmitted, had a complication or mortality, and a higher proportion were discharged to home (Table 1). NEPL patients also had a shorter median LOS. At non-LSH, compared to EPL patients, a higher proportion of NEPL patients were readmitted, had a complication, or were discharged home. NEPL patients at non-LSH had a longer median LOS and lower mortality rate compared to EPL patients. On adjusted analysis, there was no difference in readmission between EPL and NEPL patients at LSH. NEPL patients at LSH had lower odds of a complication or mortality, higher odds of discharge to home and shorter median LOS compared to EPL patients. At non-LSH, NEPL patients had an increased odds in readmission, discharge to home, and longer LOS compared to EPL patients. There was no difference in complications or mortality at non-LSH between EPL and NEPL patients.

Conclusions:

NEPL patients with cancer had lower complications, readmissions, and mortality compared to EPL patients when cared for at LSH, however, at non-LSH, they had higher rates of readmission compared to EPL patients. Given that a greater proportion of patients with NEPL are cared for at LSH, these hospitals may be equipped with support services to serve a linguistically diverse population with cancer.

Learning Objectives:

Upon completion, participant will be able to define a language serving hospital.
Upon completion, participant will be able to recognize differences in health outcomes in patients with cancer who don't speak English as a primary language.
Upon completion, participant will be able to identify the need for greater language access services to improve cancer and surgical care outcomes at all hospitals.