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Language Matters

Race, Trust, and Outcomes in the Pediatric Emergency Department

Fields, Arielle MD; Abraham, Manjusha MD; Gaughan, John PhD; Haines, Christopher DO; Hoehn, K. Sarah MD, MBe

doi: 10.1097/PEC.0000000000000453
Original Articles

Objective Trust in physicians and health care system has been positively associated with health care outcomes. The purpose of this study is to explore the relationships among race, ethnicity, language, trust, and health care outcomes.

Methods This prospective cross-sectional study took place in the pediatric emergency department of an intercity hospital. English- and Spanish-speaking guardians were asked to complete a demographic survey, the Pediatric Trust in Physicians Scale, and the Group-Based Medical Mistrust Scale.

Results Four hundred seventy-five parents were surveyed, of which 21.35% identified as white, 35.05% as African American, and 53.26% as Hispanic; with respect to language: 88% English-speaking and 12% Spanish-speaking. No significant difference was seen in trust scores for sex, ethnicity, or religious affiliation. Non-Hispanics and English speakers demonstrated an overall higher trust in their physician. English-speaking participants were found to have higher percentages in all measured emergency department variables compared to Spanish speakers, including admittance (9.09% and 0.93%, respectively) as well as receiving interventions (42.34% and 5.53%, respectively).

Conclusions Our study shows that race and ethnicity influence trust and mistrust as well as actual health care outcomes. Interestingly, language barrier proved to be one of the greatest causes of health care disparities. Therefore, more research is needed to find a way to bridge the increasing language barrier between physicians and patients.

From the *Thomas Jefferson University, Philadelphia, PA; †Kansas University School of Medicine, Kansas City, KS; ‡Biostatistics Consulting Center, Temple University School of Medicine, Philadelphia, PA; and §Children's Specialized Hospital, New Brunswick, NJ.

Disclosure: The authors declare no conflict of interest.

Reprints: Manjusha Abraham, MD, PGY 3, University of Kansas School of Medicine, 3901 Rainbow Boulevard, MS 4004, Kansas City, KS 66160 (e-mail:

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