Health Disparities
Disparities in hospital length of stay among inpatient surgical patients by sex, race, ethnicity, and language spoken Bridget Lally* Bridget Lally Lally Lally University of Wisconsin-Madison
Objective: The purpose of this study is to determine if there are disparities in hospital length of stay (LOS) among inpatient surgical patients by sex, race and ethnicity and evaluate language as an effect modifier of that relationship.
Method: The dataset included 39,503 inpatient surgical patients over the age of 18 from a single health system that underwent any surgical procedure between 2017 and 2023. An inverse gaussian generalized linear model estimated the relationship between LOS and race, ethnicity, sex, and language spoken (English or not English). The model controlled for BMI, age, anesthesia type, surgical specialty, and comorbid mental health and substance use disorders. Interactions between language spoken and sex, ethnicity and race were tested and stratified analyses were conducted for English and non-English speaking males and females and for each racial and ethnic group.
Results: Patients were an average age of 57.7 (SD: 16.8), 50.7% were male, 92.2% were white, 3.3% Hispanic and 1.9% spoke a language other than English. There were statistically significant interactions between language and patient sex (p=.003) as well as language and white/non-white patient race (p=.024). Patients with Hispanic/Latino ethnicity, males, and males speaking a language other than English experienced longer LOS. Stratified analyses revealed that male patients who spoke a language other than English experienced the longest LOS (mean ratio 1.57, 95% CI 1.31,1.89, reference: English-speaking females), and 3 of the 4 non-English speaking racial and ethnic subgroups experienced approximately 40% longer LOS. English-speaking, white, Hispanic individuals and non-white, non-Hispanic individuals experienced a 25.5% and 21.1% longer LOS, respectively, relative to White, Non-Hispanic, English-Speaking individuals.
Conclusion: Disparities in LOS are evident between sex, racial, ethnic, and language groups. Results support language as an effect modifier in the relationship between sex, race, ethnicity and LOS. Additional support for patients speaking languages other than English should be considered to ensure timely release from the hospital following surgery.