Limited English Proficient Patient Visits and Emergency Department Admission Rates for Ambulatory Care Sensitive Conditions in California: a Retrospective Cohort Study



Little is known about the risk of admission for emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs) by limited English proficient (LEP) patients.


Estimate admission rates from ED for ACSCs comparing LEP and English proficient (EP) patients and examine how these rates vary at hospitals with a high versus low proportion of LEP patients.


Retrospective cohort study of California’s 2017 inpatient and ED administrative data


Community-dwelling individuals ≥ 18 years without a primary diagnosis of pregnancy or childbirth. LEP patients had a principal language other than English.

Main Measures

We used a series of linear probability models with incremental sets of covariates, including patient demographics, primary diagnosis, and Elixhauser comorbidities, to examine admission rate for visits of LEP versus EP patients. We then added an interaction covariate for high versus low LEP-serving hospital. We estimated models with and without hospital-level random effects.

Key Results

These analyses included 9,641,689 ED visits; 14.7% were for LEP patients. . Observed rate of admission for all ACSC ED visits was higher for LEP than for EP patients (26.2% vs. 25.2; p value < .001). Adjusted rate of admission was not statistically significant (27.3% [95% CI 25.4–29.3%] vs. 26.2% [95% CI 24.3–28.1%]). For COPD, the difference was significant (36.8% [95% CI 35.0–38.6%] vs. 33.3% [95% CI 31.7–34.9%]). Difference in adjusted admission rate for LEP versus EP visits did not differ in high versus low LEP-serving hospitals.


In adjusted analyses, LEP was not a risk factor for admission for most ACSCs. This finding was observed in both high and low LEP-serving hospitals.

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The authors would like to acknowledge Lisa Marks for her technical support.


This work was supported in part by a Health Resources and Services Administration’s National Research Service Award (T32HP10028) (Dr. Schulson), Agency for Healthcare Research and Quality Award (T32HS022242) (Dr. Lin), and National Institute on Minority Health and Health Disparities Grant R01MD011594 (Dr. Hanchate).

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Correspondence to Lucy Schulson MD, MPH.

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Schulson, L., Lin, MY., Paasche-Orlow, M.K. et al. Limited English Proficient Patient Visits and Emergency Department Admission Rates for Ambulatory Care Sensitive Conditions in California: a Retrospective Cohort Study. J GEN INTERN MED (2021).

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  • limited English proficiency
  • health disparities
  • ambulatory care sensitive conditions