Non-Spanish NEPL had increased odds of emergency surgery (OR 2.29) for diverticulitis

Description #

In the language-subgroup multivariable analysis, non-Spanish NEPL patients (primary language neither English nor Spanish) had significantly increased odds of emergency versus elective surgery for diverticulitis compared to EPL patients, with an odds ratio of 2.29 (95% CI 1.78–2.97; P < 0.001) — roughly a 2.3-fold higher odds, and a substantially larger effect than the overall NEPL estimate (OR 1.35) (Table 3 subgroup analysis, reported in text). This is the highest-risk subgroup in the study.

"More specifically, while Spanish NEPL patients had no significantly different odds of emergency surgery (OR 0.80; 95% CI 0.63-1.03; P = 0.077) compared to EPL patients, patients with non-Spanish NEPL had significantly increased odds of emergency surgery (OR 2.29; 95% CI 1.78-2.97; P <0.001) compared to patients with EPL." (Maurer, 2021, p. 645)

Methods Context #

What? #ⓘ

The observable: emergency (urgent/emergent) versus elective surgical admission type, with primary language sub-categorized into non-Spanish NEPL versus EPL (reference).

"Primary language was dichotomized into NEPL versus English primary language (EPL), and further sub-categorized into Spanish versus non-Spanish NEPL." (Maurer, 2021, p. 644)

How? #ⓘ

Multivariable logistic regression with the same covariate set (age, sex, insurance, income quartile, data year, CCI), estimating odds of emergency surgery for non-Spanish NEPL relative to EPL patients.

"All models were controlled for age, sex, insurance status, median household income quartile, data year, and Charlson Comorbidity Index (CCI)18 in multivariable regression models." (Maurer, 2021, p. 645)

Who? #ⓘ

The 292 non-Spanish-primary-language patients (of 592 NEPL) among 9,453 adult diverticulitis surgery patients in the New Jersey State Inpatient Database; the SID classified the majority of this group's primary language as "Other."

"Among NEPL patients, 300 (51%) had Spanish as primary language and 292 (49%) had another non-Spanish primary language." (Maurer, 2021, p. 643)

Other Notes #

Unadjusted descriptive rate (Table 2): 202 of 292 non-Spanish NEPL patients (69.2%) underwent emergency surgery, versus 51.7% for Spanish NEPL. The authors interpret the elevated non-Spanish risk as reflecting fewer language services for less-common languages. Interpretation of this subgroup is limited because most were coded primary language "Other" (see qualifying caveat).

Caveats #

• Single-state New Jersey inpatient data limits generalizability of the diverticulitis language findings The analysis draws on only the New Jersey State Inpatient Database, chosen because primary-language coding was not uniformly available across other states' SIDs. Because state-by-state policy (including availability of language services) can influence access and outcomes, the findings — and especially the Spanish-versus-non-Spanish contrast, which the authors tie to New Jersey's large Spanish-speaking population and services — may not transfer to other states or settings.
• Retrospective single-database diverticulitis study precludes causal inference and leaves residual confounding The study is a retrospective analysis of a single administrative claims database, so it can establish association but not causation between non-English primary language and emergency surgery. Residual confounding is likely on two additional counts the authors flag: income was available only as an ecological, neighborhood-level (FIPS) measure rather than individual income, and the State Inpatient Database offers no longitudinal patient linkage, so prior diverticulitis admissions and the true denominator of overall disease burden per patient are unknown. Together these limit adjustment for socioeconomic status and disease chronicity, so the adjusted odds ratios should be read as associational estimates that may retain uncontrolled confounding.
• Non-Spanish NEPL diverticulitis patients were mostly coded primary language Other, limiting subgroup interpretation The highest-risk subgroup — non-Spanish NEPL patients — is difficult to interpret because the State Inpatient Database classified the majority of them under a single catch-all primary language of "Other," providing no specific-language granularity. Race/ethnicity data confirm this is a distinct group from Spanish NEPL patients (fewer than 10% self-identify as Hispanic), but the heterogeneous "Other" coding prevents attributing the elevated OR 2.29 to any particular language community or to language-service availability for specific languages.