Non-English–speaking patients hospitalized with COVID-19 are at risk of worse health outcomes

Researchers at Mass General Brigham report that racial and ethnic minority patients continue to be disproportionally affected by COVID-19

Key Takeaways

  • A new study reports that Hispanic/Latino patients comprised close to one-third of all COVID-19-related hospital admissions during the early wave of the pandemic, more than three times their pre-COVID-19 level, and that patients with limited or no English language skills had 35 percent greater odds of suffering serious health outcomes compared with English speakers.
  • Since the early-stage of the pandemic, hospitals and health systems have become more aware of language-based inequities and taken such steps as increasing availability of in-person interpreters, translating and distributing relevant educational materials, and funding language-appropriate vaccination programs.
  • Hospitals can’t afford to let their guard down even as the pandemic subsides; they must continue to invest in programs and policies that reduce communication inequities and provide greater support for patients with limited English proficiency.

The language status of patients hospitalized for COVID-19 may significantly impact health outcomes during their admission, as non-English speaking individuals were found to have 35 percent greater odds of dying or requiring intensive care unit (ICU) support during the earliest phase of the pandemic compared to English-speaking patients, according to a study by Mass General Brigham (MGB). While improvements have since occurred, researchers discovered that sociodemographic disparities continue to disproportionately affect COVID-19 hospitalization and clinical outcomes of minority patients, creating the need for additional interventions at both hospital and community levels to close the equity gap. The results were published in Journal of Racial and Ethnic Health Disparities.

“This is one of the first studies to demonstrate a direct relationship between language status and health outcomes during COVID-19 hospitalizations, and we hope these findings can serve as a cautionary reminder to hospitals everywhere to proactively address the communication needs of patients with limited English proficiency prior to future surges of the virus,” says lead author Priscilla Wang, MD, a general internist at Massachusetts General Hospital and population health specialist. “Fortunately, language-based inequities are correctable and improvements are starting to take place through, for example, greater messaging and materials in different languages provided within hospital and community settings.”

Researchers studied nearly 10,000 primary care patients admitted to the Mass General Brigham Health System with COVID-19 between March 1, 2020 and March 1, 2021, dividing the pandemic-intensive period into two six-month “waves.” The retrospective analysis found that Hispanic/Latino patients comprised close to one-third of all COVID-19-related admissions during the first wave, more than three times their pre-COVID-19 proportion. Similarly, the proportion of non-English-speaking patients admitted increased fourfold from pre-pandemic rates. While these numbers remained greatly skewed toward minority and immigrant populations during the second wave, investigators did find improved clinical outcomes. Specifically, fewer patients admitted with COVID-19 developed severe illness or died compared to the first wave, and the association between language and severe COVID-19 outcome also disappeared in the second wave. 

“Increased access to novel therapeutics and vaccinations may have contributed to these changes, but we believe improved support for patients with limited English proficiency within the acute care setting also played a major role in our health system,” notes Wang, who served in a COVID-19 ICU in the early stage of the pandemic. At Mass General Brigham, those changes have included increasing in-person interpreter availability, investing in video-based interpretation equipment for isolation rooms, and increasing availability of informational materials translated into common languages. As the study points out, an equally urgent need exists within communities for language-appropriate vaccination campaigns targeting highly impacted minority members, and for translation of relevant primary care-based educational materials. 

“The progress we’ve seen between the first and second waves of the pandemic suggests it is possible to close language-based disparity gaps in patient outcomes with focused interventions,” emphasizes Wang. “But now is not the time to let our guard down. Serious inequities still remain, making it more important than ever for health systems to make continued investments in programs and policies that support patients with limited English proficiency.”

Wang is a primary care physician at Massachusetts General Hospital and a population health fellow at Mass General Brigham. Co-authors include Gregg S. Meyer, MD, MSc, president of the Community Division and executive vice-president of Value-Based Care for MGB; Harrison Hubbell, senior healthcare data analyst at MGB; and Po-Yu (Alex) Lai, senior director of Enterprise Analytics in MGB Population Health Management.

About Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In August 2021, Mass General was named #5 in the U.S. News & World Report list of "America’s Best Hospitals." MGH is a founding member of the Mass General Brigham healthcare system. 

About Mass General Brigham

Mass General Brigham is an integrated academic healthcare system, uniting great minds in medicine to make life-changing impact for patients in our communities and people around the world. Mass General Brigham connects a full continuum of care across a system of academic medical centers, community and specialty hospitals, a health insurance plan, physician networks, community health centers, home care, and long-term care services. Mass General Brigham is a non-profit organization that is committed to patient care, research, teaching, and service to the community. In addition, Mass General Brigham is one of the nation’s leading biomedical research organizations and a principal teaching affiliate of Harvard Medical School. For more information, please visit massgeneralbrigham.org.

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