O1003: Disparities in Care of Non English Proficient Patients with Congenital Heart Disease

Background: The medical and public health community has begun to recognize important disparities in health care delivery and outcomes, including for patients with congenital heart disease (CHD). Hispanic ethnicity has been identified as a risk factor for readmission and overall mortality after congenital heart surgery (CHS). Population-based studies have identified that risk of mortality as it relates to race and ethnicity varied by region, indicating variables other than patient biology as contributors. However, studies on the impact of language of preference on variabilities in care and outcomes, and ideas for systematic quality improvement in this field, are lacking in the current literature for the CHD population.

Methods: This is a single center retrospective review of patients undergoing CHS between 2018 and 2020. The data collected included caregiver preferred language, other demographic characteristics, and overall outcomes after undergoing CHS. Patients with no listed preferred language were excluded. For patients undergoing more than one CHS, the highest STAT category surgery was selected for analysis, and the remainder were excluded. Patient demographics, LOS, STAT category, 30-day readmission rate, and operative mortality were compared between LEP and EP patients, with descriptive statistics, univariate and multivariate analyses. A p< 0.05 was considered statistically significant.

Results: After excluding repeat procedures, 533 patients were eligible for review: 449 (84.2%) whose families preferred English (EP) and 84 (15.8%) whose families preferred a language other than English (LEP). A lower incidence of Hispanic ethnicity was observed in the EP compared to LEP (36% vs. 79%, p< 0.001), with no other significant demographic differences (Table 1).
The EP group had a significantly shorter median LOS (7 [4-20] vs. 10 [5-41] days, p=0.032) compared to the LEP group. This difference remained significant after controlling for sex, race, ethnicity, presence of prenatal diagnosis, STAT category, and mortality (p=0.001). There were no statistically significant differences in 30-day readmission or mortality between the two groups (Table 1).
After stratifying results by STAT category, the ethnicity difference remained significant between STAT 1 and 4 categories, with less Hispanic patients in the EP group (Table 2). Moreover, for the STAT 5 category, a shorter LOS was observed in the EP group (44.5 [25.25-109.75]), compared to LEP patients (217.5 [200.8-234.2], p=0.042), with no demographic differences between the groups.

Conclusion: This study suggests potential differences in outcomes of patients with CHD related to their language of preference, specifically a longer LOS after undergoing CHS. The etiology of this finding is likely multifactorial, and thus, warrants further investigation to identify specific areas for improvement in ensuring equitable hospital based care of LEP patients with congenital heart disease.