Analysis of socioeconomic factors in laryngology clinic utilization for treatment of dysphonia

Abstract

Objective: To evaluate the association between patient socioeconomic and demographic factors and tertiary care utilization for dysphonia in a localized metropolitan area of the American Midwest.Methods: Multivariate regression analysis was used to correlate patient demographics and population level data (e.g., age, gender, race, insurance, median income, education level) with tertiary laryngology utilization for dysphonia care at our institution between 2000 and 2019. Initial analyses characterized tertiary laryngology utilization rates for all regional ZIP codes and correlated these data with census information for household income and education. Dysphonia patient demographics were compared among populations cared for in our entire academic Otolaryngology department, our health system, and the regional population.Results: Among 1,365,021 patients in our health system, there were 7066 tertiary laryngology visits with a diagnosis of dysphonia. Dysphonia patients as compared to the overall health system were older (62.0 vs. 50.8 years), more likely to be female (63.7 vs. 50.2%) and more likely to have insurance (98.4 vs. 87.5%, all p < .001).Patient and population-level factors including insurance status, education, and black race showed positive correlation with laryngology utilization while median income did not. Conclusions and Relevance:Insurance status, education level, and race correlated with utilization of tertiary laryngology services for the evaluation of dysphonia in our community, while median income did not. Black patients utilized tertiary laryngology care at higher rates compared to departmental and regional population utilization data. These results underscore important demographic and disease-specific factors that may affect utilization of subspecialty care in Otolaryngology.

Demographic differences in the treatment of unilateral vocal fold paralysis

“…A recent study from our department showed that utilization of tertiary laryngology services for overall dysphonia care was correlated with race, insurance status, and level of education. 11 This current study shows that patient gender, ethnicity, and insurance status significantly correlated with differing treatment pathways.…”

“…A recent report examining racial/ethnic and gender disparities in various laryngeal disorders highlighted the significant need for further studies to determine the impact of health care disparities on tertiary laryngology care 10 . A recent study by our group found no significant racial barriers to care access for evaluation of generalized dysphonia within our tertiary referral network 11 . We hypothesized that social determinants of health may alter the management of UVFP, and therefore utilized our local health care network to measure associations between patient demographics and social determinants of health on UVFP treatment pathways.…”

“… 10 A recent study by our group found no significant racial barriers to care access for evaluation of generalized dysphonia within our tertiary referral network. 11 We hypothesized that social determinants of health may alter the management of UVFP, and therefore utilized our local health care network to measure associations between patient demographics and social determinants of health on UVFP treatment pathways.…”

Association of Sociodemographic Factors on the Presentation and Management of Unilateral Vocal Fold Immobility

“…41 White et al found associations between insurance, education, and race with utilization of tertiary-level laryngology care services. 42 Another study by Patel et al found that gender, ethnicity, and insurance were associated with differences in UVFI treatment, however, clinical factors were not considered. 43 Confounding clinical factors need to be considered in multivariable logistic regression models so that adjusted weights determine the effect size of SDOH variables.…”

Evaluation of Social Determinants of Health on Dysphagia Care Pathways at a Tertiary Care Facility

“…7 Recent sociodemographic analyses have shown significant differences in rates of laryngology service utilization across areas within Southeast Wisconsin for otolaryngological pathologies, such as dysphonia and chronic rhinosinusitis. 8 However, research on how social determinants of health impact care patterns for management of dysphagia have been sparse. A recent Scoping review identified less than 10 total articles studying health disparities relevant to dysphagia care.…”