Impact of Limited English Proficiency On Survival Among Patients with Hepatocellular Carcinoma
Jason Wade1, Aprille Gangi2, Michael Einstein3, Glyn Morgan1, Bishoy Emmanuel1, Wasim Dar1, Elizabeth Richardson3, Eva Urtasun Sotil3, Colin Swales3, william Sardella1, Oscar Serrano1
1Surgery, Hartford Hospital, Hartford, Connecticut, United States, 2Trinity College, Hartford, Connecticut, United States, 3Hartford Hospital, Hartford, Connecticut, United States
Objective: Limited English proficiency (LEP) among patients is known to negatively impact health outcomes. However, little is known about survival of hepatocellular carcinoma (HCC) patients with LEP compared to English proficient (EP) patients.
Design: A single-institution retrospective cohort analysis of HCC patients was performed. Patients were identified by ICD-10 codes. Demographics, cancer-specific details, language preference and social determinants of health (SDH) were collected for all patients. Patients were classified as EP or LEP based on their preferred spoken language (English vs other). The association of LEP with 1-year, 3-year and overall survival was assessed using Mantel-Cox analysis.
Setting: Tertiary care referral and transplant center
Patients: Patients diagnosed with HCC between March 1, 2017 and March 31, 2021. Patients were excluded if their care was transferred to another institution.
Interventions: N/A
Main Outcome Measures: Survival
Results: Of 328 patients, 47 (14.3%) were LEP and 281 (85.7%) were EP. Median age was 65 (interquartile range [IQR] 61-72) and 62 (18.9%) were female. Compared to EP patients, LEP patients demonstrated inferior 1-year (58.6% vs. 71.5%), 3-year (38.4% vs. 46.2%), and overall survival (25.6% vs. 32.7%). LEP patients were less likely to have a liver transplant (2.7% vs. 13.2%) or a liver resection (10.8% vs. 16.2%). When evaluating SDH and demographic factors, both groups had similar rates of social support, tobacco use and alcohol use; however differences were noted with respect to rates of marriage or domestic partnership (32.4% for LEP vs. 48.7% for EP), unemployment (43.2% vs. 31.1%), private insurance (2.7% vs. 11.3%), White race (13.5% vs. 75.4%), and Hispanic ethnicity (75.7% vs. 11.3%).
Conclusions: LEP appears to be associated with a decreased survival among HCC patients. Notable differences were noted in SDH in LEP patients. Further research is needed to determine how these differences contribute to the overall findings in this study.
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