Demographic differences in the treatment of unilateral vocal fold paralysis

Abstract

Objective: To determine the impact of patient demographics and social determinants of health on treatment pathways for unilateral vocal fold paralysis (UVFP) at a tertiary laryngology clinic.Study design: Retrospective medical record review.Methods: Patient demographics (age, gender, race, ethnicity, and insurance status) were extracted for adults diagnosed with UVFP between 2009 and 2019. Odds ratios for the associations between sociodemographic factors and UVFP treatment pathways were determined by chi-square analyses.Results: A total of 1490 UVFP diagnoses were identified during the study period with the majority being female (58%), White (85%), non-Hispanic (97%), and publicly insured (54%). Five treatment pathways were identified: observation, injection laryngoplasty, voice therapy, laryngeal framework surgery/thyroplasty, and reinnervation surgery. There were 538 patients who underwent observation, 512 injection laryngoplasty, 366 voice therapy, 136 thyroplasty, and 26 laryngeal reinnervation surgery.Males were more likely to undergo injection laryngoplasty than females (OR 1.32; CI 1.08-1.61), whereas females were more likely to undergo voice therapy (OR 1.39; CI 1.09-1.76). Patients with public insurance (OR 1.48; CI 1.03-2.14) and Hispanics (OR 2.60; CI 1.18-5.72) were more likely to undergo thyroplasty. Patients who underwent reinnervation surgery were younger than those in other treatment pathways (median: 39.1 years vs. 50.7-56.1 years).Conclusions: Gender, ethnicity, and insurance status were significantly associated with specific UVFP treatment pathways. Patients with public insurance were more likely to undergo surgical intervention than voice therapy. This data overall supports differences in care pathway utilization for UVFP based on social determinants of health.

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

“…Their study included 1490 adult patients with 58% female, 97% non-Hispanic, and 54% publicly insured patients undergoing observation, voice therapy, injection laryngoplasty, thyroplasty, and reinnervation surgery. 43 They similarly found that males were more likely to undergo injection laryngoplasty than females (OR 1.32; CI 1.08-1.61) and that females were more likely to undergo voice therapy (OR 1.39; CI 1.09-1.76), although they found no gender association with surgical interventions. This supports the findings of Cohen et al that females had lower expenditures for a range of laryngeal disorders compared to males.…”

“…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. 43 Our work adds to the existing literature investigating the effects of SDOH on the presentation and management of UVFI.…”

“…43 Confounding clinical factors need to be considered in multivariable logistic regression models so that adjusted weights determine the effect size of SDOH variables. 43 Our work adds to the existing literature investigating the effects of SDOH on the presentation and management of UVFI.…”

“…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 43 .…”

“…A recent article by Patel et al investigated demographic differences in the treatment of unilateral vocal fold paralysis. Their study included 1490 adult patients with 58% female, 97% non‐Hispanic, and 54% publicly insured patients undergoing observation, voice therapy, injection laryngoplasty, thyroplasty, and reinnervation surgery 43 . They similarly found that males were more likely to undergo injection laryngoplasty than females (OR 1.32; CI 1.08–1.61) and that females were more likely to undergo voice therapy (OR 1.39; CI 1.09–1.76), although they found no gender association with surgical interventions.…”