Postdischarge Outcomes and Health Care Utilization Among Hispanic/Latinx Injury Survivors: English-language Proficiency Matters.

Abstract

We sought to compare postdischarge outcomes and health care utilization between English-speaking non-Hispanic White (NHW), English-speaking Hispanic/Latinx (ESHL), and Spanish-speaking Hispanic/Latinx (SSHL) survivors of traumatic injury. While there is evidence of racial and ethnic disparities in health care utilization and postdischarge outcomes after injury, the role of English-language proficiency in these disparities remains unclear. Moderate to severely injured adults from 3 level-1 trauma centers completed an interview in English or Spanish between 6 and 12 months postinjury to assess physical health-related quality-of-life (SF-12-PCS), return to work, and postdischarge health care utilization. The language used in the interview was used as a proxy for English-language proficiency, and participants were categorized as either NHW (reference), ESHL, or SSHL. Multivariable regression models estimated independent associations between language and race/ethnicity with SF-12-PCS, return to work, and postdischarge health care utilization outcomes. A total of 3304 injury survivors were followed: 2977 (90%) NHW, 203 (6%) ESHL, and 124 (4%) SSHL. In adjusted analyses, no significant differences were observed between ESHL and NHW injury survivors for any outcomes at 6 to 12 months postinjury. However, SSHL injury survivors exhibited a lower mean SF-12-PCS (41.6 vs. 38.5), -3.07 (95% CI=-5.47, -0.66; P =0.012), decreased odds of returning to work [odds ratio (OR)=0.47; CI=0.27-0.81; P =0.007], and were less likely to engage in non-injury-related outpatient visits, such as primary care visits (OR=0.45; 95% CI=0.28-0.73; P =0.001), compared with NHW patients. Hispanic/Latinx injury survivors have worse postdischarge outcomes and lower non-injury-related health care utilization than NHW if they have limited English-language proficiency. Addressing LEP-related barriers to care could help mitigate outcome and health care utilization disparities among Hispanic/Latinx injury survivors.