The impact of social determinants of health on laryngotracheal stenosis development and outcomes

Abstract

Objectives The social determinants of health affect a wide range of health outcomes and risks. To date, there have been no studies evaluating the impact of social determinants of health on laryngotracheal stenosis (LTS). We sought to describe the social determinants in a cohort of LTS patients and explore their association with treatment outcome. Methods Subjects diagnosed with LTS undergoing surgical procedures between 2013 and 2018 were identified. Matched controls were identified from intensive care unit (ICU) patients who underwent intubation for greater than 24 hours. Medical comorbidities, stenosis characteristics, and patient demographics were abstracted from the clinical record. Tracheostomy at last follow‐up was recorded from the medical record and phone calls. Socioeconomic data was obtained from the American Community Survey. Results One hundred twenty‐two cases met inclusion criteria. Cases had significantly lower education compared to Tennessee (P = .009) but similar education rates as ICU controls. Cases had significantly higher body mass index (odds ratio [OR]: 1.04, P = .035), duration of intubation (OR: 1.21, P < .001), and tobacco use (OR: 1.21, P = .006) in adjusted analysis when compared to controls. Tracheostomy dependence within the case cohort was significantly associated with public insurance (OR: 1.33, P = .016) and chronic obstructive pulmonary disease (OR: 1.34, P = .018) in adjusted analysis. Conclusion Intubation practices, medical comorbidities and social determinants of health may influence the development of LTS and tracheostomy dependence after treatment. Identification of at‐risk populations in ICUs may allow for prevention of tracheostomy dependence through the use of early tracheostomy and specialized follow‐up. Level of Evidence Level 3, retrospective review comparing cases and controls Laryngoscope, 130:1000–1006, 2020

Association of Social Determinants of Health with Time to Diagnosis and Treatment Outcomes in Idiopathic Subglottic Stenosis

“…Investigation of clinical factors affecting treatment outcomes in post-intubation laryngotracheal stenosis (iLTS) demonstrated an association between low SDH and longterm tracheostomy dependence after open reconstruction. 14 The present study did not find any differences in time to recurrent surgical procedure due to income or education. However, the patient characteristics and clinical outcomes of a localized fibroinflammatory disorder follow very different trajectories than those of critical illness.…”

“…[7][8][9][10][11][12][13] Previous work has demonstrated the association of SDH on surgical outcomes in post-intubation laryngotracheal stenosis. 14 To date, no study has investigated the effects of SDH on iSGS clinical outcomes.…”

Socioeconomic Influences on Short‐term Postoperative Outcomes in Patients With Oral Cavity Cancer Undergoing Free Flap Reconstruction

“…Social determinants of health (SDHs) 37 have been well studied for contributing to health outcomes in many acute and chronic conditions and for being an independent predictor of overall life expectancy. 37-42 SDH factors are generally categorized into 5 interconnecting domains: economic stability, education, access to health services, home neighborhood, and social and community systems. 37,43 In head and neck cancer, SDHs have been shown to contribute to the risk of disease development, the extent of disease at time of presentation, and long-term overall survival.…”

Healthcare Disparities in Laryngology: A Scoping Review

“…The principal finding of this study was that public versus private insurance was associated with increased likelihood of tracheostomy dependence in a retrospective review of 122 laryngotracheal stenosis patients (odds ratio 1.33, 95% CI 1.06-1.66, P = .016). 73…”