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Children From Families Speaking Languages Other Than English or Spanish, Medical Complexity and PICU Utilization:
Zachary Pitkowsky1,2, Amanda Warniment2,3, Joelle Kane2,3,4
1Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Objectives:
Children with medical complexity (CMC) account for a disproportionate share of PICU utilization. Children from families speaking languages other than English (LOE) face barriers that may influence critical-care needs. We sought to evaluate the intersection of language and PICU utilization of CMC.
Design:
Retrospective cohort study.
Setting:
Large quaternary children's hospital in the United States, from 2015 to 2022.
Patients:
CMC, defined as having two or more body systems involved in a complex chronic condition (CCC), admitted to a children's hospital. Patient family language categorized as English, Spanish, or languages other than English or Spanish (LOES).
Interventions:
None.
Measurements And Main Results:
We identified 3096 unique CMC (54% male) accounting for 9297 hospital encounters (mean age 8.2 yr). Among patient families, 7.2% had a preferred LOE, with 2.7% speaking Spanish and 4.6% speaking LOES. Around one-third (35%) of patients had a PICU admission during at least one encounter. Mixed-effects regressions with patient-specific random effects were used to model associations. LOES was associated with greater odds of PICU admission (adjusted odds ratio 1.58; 95% CI, 1.1-2.2) and longer PICU length of stay (incidence-rate ratio 2.4; 95% CI, 1.7-3.5) after adjusting for age, sex, race, Child Opportunity Index (COI) and the number of CCC.
Conclusions:
In patients admitted to our children's hospital (2015-2022), the CMC from families speaking a LOES represented a vulnerable subgroup, with associated greater odds of PICU admission and longer stays. These disparities persisted after accounting for CCCs and COI. Timely, language-concordant communication-especially for less common languages-may mitigate aspects of critical care admission in this population.
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