Linguistic isolation correlates with length of stay and mortality for pediatric oncology patients in California

Abstract

Abstract Objective To evaluate social drivers of health and how they impact pediatric oncology patients' clinical outcomes during pediatric intensive care unit (PICU) admission via correlation with patient ZIP codes. Methods Demographic, clinical, and outcome variables from Virtual Pediatric Systems®, LLC for oncology patients (2009–2021) in California PICUs (excluding postoperative) using 3‐digit ZIP Codes with social drivers of health variables linguistic isolation, poverty, race/ethnicity, and education abstracted from American Community Survey data for 3‐digit ZIP Codes using the Environmental Protection Agency's EJScreen tool. Outcomes of length of stay (LOS), mortality, acuity scores, were compared with social variables. Results Positive correlation between mortality and minority racial groups (Hispanic/Latino) across ZIP Codes (correlation coefficients of 0.45 (95% CI: 0.22–0.64, p < 0.001) in 2017, 0.50 (95% CI: 0.27–0.68, p < 0.001) in 2018, 0.33 (95% CI: 0.07–0.54, p = 0.013) in 2020, and 0.32 (95% CI: 0.06–0.53, p = 0.018) in 2021). Median PICU length of stay significantly correlated with linguistic isolation (coefficient of 0.42 (95% CI: 0.18–0.61, p = 0.001) in 2021 versus −0.41 (95% CI: −0.61 to −0.16, p = 0.002) in 2019), which included PRISMIII (n = 7417). Mixed effects logistic regression model for other constant variables (PRISMIII, cancer type, race/ethnicity, year), random effect of patient, linguistic isolation (percentage as a continuous value) was significantly associated (95% CI: 1.01–1.06; p = 0.02) with mortality; (OR = 1.03). Conclusions Linguistic isolation was correlated with LOS and mortality, however variable year to year.

Keywords

• cancer
• health disparities
• health inequities
• linguistic isolation
• medical length of stay
• mortality