Association of primary spoken language and noninvasive ventilation failure in hospitalized adults

Noninvasive (NIV) failure (progression from NIV to intubation) is associated with high risk of death. Impaired patient-provider communication may increase risk of failure. We investigated associations between primary spoken language (PSL) and NIV failure.

In this retrospective cohort study using the 2021 State Inpatient Database from California, Iowa, and Maryland, we identified adult patients treated with NIV. The primary exposure was PSL categorized as English, Spanish, or non-English/non-Spanish. Mixed-effects models were used to determine the adjusted odds (aOR) of NIV failure based on PSL.

Among 57,215 patients who received NIV, 83.5% had English, 11.6% had Spanish, and 5.0% had non-English/non-Spanish PSL. Patients with Spanish PSL had higher incidence of NIV failure compared to English PSL (31.8% vs 20.3%, aOR = 1.63, 95% CI 1.52-1.74) but no difference was observed between non-English/non-Spanish PSL and English PSL (18.8% vs 20.3%, aOR = 1.08, 95% CI 0.97-1.20). NIV failure-related mortality was high. Patients with Spanish PSL with NIV failure died at higher rates compared to English PSL (69.7% vs 56.5%, aOR = 1.45, 95% CI 1.30-1.63) but no difference between non-English/non-Spanish PSL and English PSL (61.1% vs 56.5%, aOR = 0.99, 95% CI 0.81-1.20). The results were robust to multiple sensitivity analyses.

NIV failure remains common and associated with high hospital mortality. Patients with Spanish PSL experience significantly higher odds of NIV failure and death compared to English PSL and even non-English/non-Spanish PSL. It is unclear why patients with Spanish PSL experience dramatically different outcomes compared to non-English/non-Spanish PSL. Future research should investigate if patients with Spanish PSL are less likely to receive formal interpreter services.