S. M. Morris2, K. McCord2, C. Annesi1, M. Zhu2, A. Zhuang2, P. Jalihal2, A. Buck3,4, L. Allee4,5 1University Of Alabama at Birmingham, Department Of Surgery, Birmingham, Alabama, USA 2Boston University, Chobanian & Avedisian School Of Medicine, Boston, MA, USA 3Boston University, Chobanian & Avedisian School Of Medicine, Department Of Graduate Medical Sciences, Boston, MA, USA 4Boston Medical Center, Department Of Surgery, Boston, MA, USA 5Boston University, Chobanian & Avedisian School Of Medicine, Department Of Surgery, Boston, MA, USA
Introduction: Neighborhoods with high socioeconomic disadvantage are shown to have higher rates of gun violence and are more likely to house populations that have limited English proficiency (LEP), which is associated with disparities in healthcare access and post-operative outcomes. Area Deprivation Index (ADI) is a composite social deprivation score calculated for each nine digit zip code in the United States. This study aims to examine the association between English Proficiency (EP) and disparities in firearm injury outcomes.
Methods: Retrospective single institution study at a safety-net Level 1 Trauma Center of adult (≥18 years) Massachusetts (MA) residents who suffered a gunshot wound from 2015-2021. Patients were identified as EP or LEP based on the primary language in the medical record. MA ADI was assigned based on patient address. Primary outcomes were in-hospital mortality, 30-day Emergency Department (ED) visits, and 30-day hospital admissions. Univariate analyses were performed with chi-square and unpaired t-tests. Multivariable logistic regression controlling for neighborhood disadvantage (ADI) and other demographic factors was used to determine the association between EP and the primary outcomes.
Results: There were 910 subjects; 94% were EP and 6% were LEP. LEP patients were significantly more likely to report Hispanic ethnicity and Non-Black race compared to EP patients. Clinical outcomes were not significantly different between EP and LEP patients on univariate analysis. Multivariable logistic regression controlling for English proficiency, neighborhood disadvantage, and demographic factors revealed that high neighborhood disadvantage independently predicted decreased in-hospital mortality (OR 0.30, 95% CI 0.10-0.92). Hispanic/Latino ethnicity independently predicted an increased likelihood of returning to the ED within 30 days (OR 1.54, 95% CI 1.03, 2.30). Age (OR 1.03, CI 1.00-1.05) and White race (OR 2.80 1.29-6.09) were independent predictors of an increased likelihood of readmission within 30 days of discharge. EP was not observed to be an independent predictor of firearm injury outcomes at this institution.
Conclusion: EP was not found to have an association with the primary outcomes at this institution. Differences in in-hospital mortality were observed across levels of socioeconomic disadvantage. Further studies are needed to address prevalent gaps in healthcare access to promote data-driven advocacy.