Socioeconomic Determinants of Tertiary Rhinology Care Utilization

Abstract

Objective The objective of this study was to determine the impact of patient demographics and socioeconomic factors on the utilization of tertiary rhinology care services in an upper Midwestern academic medical center. Study Design Retrospective review of electronic health records. Setting Academic medical center. Methods The electronic health record of our academic center was interrogated for the demographics and diagnosis of chronic rhinosinusitis (CRS) among adult patients seen by fellowship-trained rhinologists from 2000 to 2019. Patient characteristics (age, sex, race, insurance status) and population-level data (median income and education level) were compared with utilization of tertiary rhinology services for CRS. Utilization rates were calculated for each regional zip code and correlated with census data for median income and education. The association between determinants of health and tertiary rhinology utilization was assessed by multivariate regression analyses. Results A total of 8325 patients diagnosed with CRS used tertiary rhinology services. Patients were older (median, 58.9 years) and more likely to be female (57.6%), White (85%), and privately insured (60%) when compared with patients seen across our hospital system ( P < .001). Adjusted analyses showed median income, education level, and White race to be independently correlated with tertiary care utilization. Private insurance alone was not an independent contributing factor to access. Conclusion Utilization of tertiary rhinology services correlated with income, race, and education level. Private insurance was not an independent factor. These results highlight social differences in determinants of access to tertiary otolaryngologic care.

Demographic differences in the treatment of unilateral vocal fold paralysis

“…Vamosi et al reported that nonwhite patient groups were associated with higher no‐show rates in voice therapy likely due to transportation availability and differences in income and education 22 . A previous study from our group found areas with the highest Black populations in our care network had lower median income and education levels and correspondingly lower utilization rates for tertiary rhinology services 23 . This highlights the importance of understanding contributing factors in adherence and compliance to therapy recommendations in addition to equitable access to specialty care.…”

“… 22 A previous study from our group found areas with the highest Black populations in our care network had lower median income and education levels and correspondingly lower utilization rates for tertiary rhinology services. 23 This highlights the importance of understanding contributing factors in adherence and compliance to therapy recommendations in addition to equitable access to specialty care.…”

Demographic Factors and Comorbid Conditions Related to Health Care Presentation Among Patients With Sinusitis

“…24 Additionally, White individuals are more likely to receive specialist care than minorities. 15,25 Thereafter, as the existing literature largely draws samples from the outpatient specialty care setting, 13,15,24,25 we suspect that increased presentation to high-acuity settings among minorities further contributes to their underrepresentation. Our sample's racial breakdown is unique in that there is a marked overrepresentation of traditionally underrepresented minorities (67.9%) compared to the existing literature that has typically analyzed samples consisting of 70% Whites or greater.…”

“…14 Meanwhile, higher income and educational attainment, along with White race, have been associated with increased utilization of outpatient rhinology care for sinusitis, despite having an overall lower incidence among these groups. 5, 15 It is important to note, additionally, that many of the aforementioned studies exhibit limited minority representation, with minorities frequently making up less than 30% of the sample. 12, 13, 15 There is, therefore, a need to study populations with larger minority representation.…”

Impact of Demographics and Clinical Features on Initial Treatment Pathway for Vestibular Schwannoma

“…This project was approved under our department-wide OTO Clinomics outcomes assessment platform, which facilitates retrospective chart reviews of our entire health system (institutional review board no. 1538127) (12,13). Using a cohort interrogation tool, i2b2, current procedural terminology codes 225.1 and D33.3 (benign intracranial tumors) were used to identify patients in our health system seen by the neurotology service between January 2009 and December 2019.…”