The Impact of Cultural and Linguistic Diversity on Sepsis Outcomes in Patients Admitted to ICUs: A Multicenter, Retrospective Cohort Study

Objectives: This study aims to investigate the effect of culturally and linguistically diverse (CaLD) status on in-hospital mortality in patients admitted to ICUs with sepsis. We hypothesize that diverse cultural and ethnic backgrounds, combined with limited English proficiency, might contribute to increased mortality in these patients. Design: Multicenter, retrospective cohort study. Setting: Adult ICUs with in South Western Sydney Local Health District (SWSLHD), New South Wales, Australia. PATIENTS: All adult patients 18 years or older, admitted to ICUs within the SWSLHD with a diagnosis of sepsis between January 1, 2012, and December 31, 2022. Interventions: None. MEASUREMENTS AND MAIN RESULTS: Primary outcome was in-hospital mortality. ICU and hospital length of stays (LOSs) and readmission within 90 days to the ICU were our secondary outcomes. To isolate the effect of CaLD status on outcomes, matching was used to balance background covariates between the CaLD and non-CaLD groups. The average marginal effect of CaLD status on in-hospital mortality was then estimated using the matched data. In the analysis, 5971 sepsis-coded admissions were included, of which 2792 (46.75%) were from patients with CaLD backgrounds. Sixteen percent (435/2792) of the CaLD patients died in hospital compared with 17% (532/3179) deaths in the non-CaLD group. In the adjusted analysis on the matched data, hospital mortality was 2.2 percentage points lower (risk difference [RD], –0.022; 95% CI, 0.044 to –0.0005; p = 0.05) in the CaLD group compared with the non-CaLD group, corresponding to a 12.4% (risk ratio, 0.876; 95% CI, 0.763–0.989; p < 0.001) reduction in relative risk. ICU LOS was shorter for the CaLD patients by 0.53 days (12.72 hr) (95% CI, –0.836 to –0.226; p < 0.001) compared with the non-CaLD group. Conclusions: Contrary to our hypothesis, in-hospital mortality after ICU admission with sepsis was lower in patients belonging to CaLD backgrounds. This effect was largely driven by patients from North African/Middle Eastern backgrounds, the largest CaLD subgroup.