title: The association between primary language spoken and all-cause mortality in critically ill patients.
abstract: OBJECTIVE
  The study objective was to investigate the association between primary language spoken and all-cause mortality in critically ill patients.
  
  
  METHODS
  We performed a cohort study on 48 581 patients 18 years or older who received critical care between 1997 and 2007 in 2 Boston hospitals. The exposure of interest was primary language spoken determined by the patient or family members who interacted with administrative staff during hospital registration. The primary outcome was 30-day mortality. Associations between language and mortality were estimated by bivariable and multivariable logistic regression models with inclusion of covariate terms thought to plausibly interact with both language and mortality. Adjustment included age, race, sex, Deyo-Charlson index, patient type (medical vs surgical), sepsis, creatinine, hematocrit, white blood count, and number of organs with acute failure.
  
  
  RESULTS
  Validation showed that primary language spoken was highly accurate for a statement in the medical record noting the language spoken that matched the assigned language. Patients whose primary language spoken was not English had improved outcomes (odds ratio 30-day mortality, 0.69 [95% confidence interval, 0.60-0.81; P < .001), relative to patients with English as the primary language spoken, fully adjusted. Similar significant associations are seen with death by days 90 and 365 as well as in-hospital mortality. The improved survival in patients with a non-English primary language spoken is not confounded by indicators of severity of disease and is independent of the specific language spoken and neighborhood poverty rate, a proxy for socioeconomic status. There are significant limitations inherent to large database studies that we have acknowledged and addressed with controlling for measured confounding and evaluation of effect modification.
  
  
  CONCLUSIONS
  In a regional cohort, not speaking English as a primary language is associated with improved outcomes after critical care. Our observations may have clinical relevance and illustrate the intersection of several factors in critical illness outcome including severity of illness, comorbidity, and social and economic factors.
authors.affiliation: Renal Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Mallika L
authors.initials: ML
authors.lastname: Mendu
authors.forename: Sam
authors.initials: S
authors.lastname: Zager
authors.forename: Takuhiro
authors.initials: T
authors.lastname: Moromizato
authors.forename: Caitlin K
authors.initials: CK
authors.lastname: McKane
authors.forename: Fiona K
authors.initials: FK
authors.lastname: Gibbons
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Christopher
mesh_terms: D001900:Boston / Q000453:epidemiology; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality*; D015987:Effect Modifier, Epidemiologic; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
keywords: Intensive care; Language; Language discordance; Language proficiency; Mortality