The impact of socioeconomic and geographic factors on access to transoral robotic/endoscopic surgery for early stage oropharyngeal malignancy

Groysman, Matthew J.; Yi, Sun; Robbins, Jared R.; Hsu, Charles C.; Julian, Ricklie; Bauman, Julie E.; Baker, Audrey; Wang, Steven J.; Bearelly, Shethal

doi:10.1016/j.amjoto.2021.103243

Cited by 5 publications

(6 citation statements)

References 16 publications

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“…Previous studies indicated that people with higher income are more likely to have a better education, reside in urban areas, and be able to afford private health insurance to better access required rehabilitation services. [17][18][19] Results of this study are in contrast to those obtained in the previous work, indicating that individuals' median income is an influencing factor for the onset of rehabilitation services. 20,21 To inform initiatives and clinical practice, future research should examine the impact of community-level versus person-level median income on the onset of rehabilitation services.…”

Section: Discussioncontrasting

confidence: 99%

“…Our findings indicated that patients living in locations with a median income above $47 500 were positively associated with the onset of rehabilitation services, meaning that those who lived in communities with greater median income than $47 500 were associated with longer time between admission and receipt of services. Previous studies indicated that people with higher income are more likely to have a better education, reside in urban areas, and be able to afford private health insurance to better access required rehabilitation services 17–19. Results of this study are in contrast to those obtained in the previous work, indicating that individuals' median income is an influencing factor for the onset of rehabilitation services 20,21.…”

Section: Discussioncontrasting

confidence: 98%

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Are Social Determinants of Health Associated With Onset of Rehabilitation Services in Patients Hospitalized for Traumatic Brain Injury?

Bukhari

Graham

Kinney

et al. 2022

Journal of Head Trauma Rehabilitation

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Objective: To examine the impact of community-level social determinants of health (SDoH) on the onset of occupational therapy (OT) and physical therapy (PT) services among individuals hospitalized for traumatic brain injury (TBI). Setting: 14 acute care hospitals in the state of Colorado. Participants: We studied 5825 adults with TBI. Design: In a secondary analysis of de-identified electronic health record data, we performed multivariable logistic and linear regressions to calculate odds ratios (ORs) and 95% CIs for the likelihood of receiving services and duration to initiation of services among those who received them. Main Measures: Community-level SDoH, receipt of rehabilitation services, and onset of rehabilitation services. Results: Multivariable logistic and linear regressions revealed that those in top quartiles for community income were associated with duration to OT services, ranging from OR = 0.33 [05% CI, 0.07, 0.60] for quartile 2 to 0.76 [0.44, 1.08] for quartile 4 compared with those with the lowest quartile. Only the top quartile differed significantly for duration to PT services (0.63 [0.28, 0.98]). Relative to those with below the median community percentage of high school degree, those with above the median were associated with duration to PT services only (−0.32 [−0.60, −0.04]). Neither community percentage with bachelor's degree nor rural-urban designation was associated with duration to either therapy service. Conclusion: Further research is needed to determine whether our SDoH variables were too diffuse to capture individual experiences and impacts on care or whether community-level education and income, and rurality, truly do not influence time to therapy for patients hospitalized with TBI. Other, individual-level variables, such as age, comorbidity burden, and TBI severity, demonstrated clear relationships with therapy onset. These findings may help therapists evaluate and standardize equitable access to timely rehabilitation services.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 98%

Are Social Determinants of Health Associated With Onset of Rehabilitation Services in Patients Hospitalized for Traumatic Brain Injury?

Bukhari

Graham

Kinney

et al. 2022

Journal of Head Trauma Rehabilitation

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“…Previous studies have shown that uninsured status and government insurances are independently related to nonsurgical management and worse survival for OPSCC patients. 1,2,6,8 One of the strengths of this study was its subgroup analysis that excluded patients with Medicaid or uninsured status. The results of this analysis were consistent with the overall findings and demonstrated that HBH was associated with increased use of primary radiation.…”

Section: Discussionmentioning

confidence: 99%

“…Outcomes of patients with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) have been shown to vary across both patient social determinants of health, including demographics and socioeconomic status, and facility characteristics. [1][2][3][4][5] Given the importance of insurance status on outcomes at the individual patient level, 1,2,[6][7][8] previous literature has attempted to expand this relationship to the facility level by evaluating a hospital's safety-net burden status. [9][10][11][12][13][14][15][16] High safety-net burden hospitals are defined as those that "organize and deliver a significant level of health care and other health-related services to uninsured, Medicaid, and other vulnerable patients".…”

Section: Introductionmentioning

confidence: 99%

“…Outcomes of patients with human papillomavirus (HPV)‐positive oropharyngeal squamous cell carcinoma (OPSCC) have been shown to vary across both patient social determinants of health, including demographics and socioeconomic status, and facility characteristics 1–5 . Given the importance of insurance status on outcomes at the individual patient level, 1,2,6–8 previous literature has attempted to expand this relationship to the facility level by evaluating a hospital's safety‐net burden status 9–16 .…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Hospital Safety‐Net Burden Status on Patients with HPV‐Positive Oropharyngeal Cancer

Gilja,

Kumar,

Kapustin

et al. 2023

The Laryngoscope

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ObjectivesThe objective of this study was to compare treatment characteristics and outcomes between patients with HPV‐positive oropharyngeal squamous cell carcinoma (OPSCC) treated at hospitals of varying safety‐net burden status.MethodsPatients with cT1‐4, N0‐3, M0 HPV‐positive OPSCC who underwent definitive surgery or radiation were included. Patients were grouped based on their treating hospital safety‐net burden status, defined as the percentage of uninsured and Medicaid‐insured patients with OPSCC treated at the facility and stratified as low burden (LBH: 0–25th percentile), medium burden (MBH: 25th–75th percentile), or high burden (HBH: 75th–100th percentile). The primary outcome was primary treatment with surgery versus radiation, evaluated with multivariable‐adjusted logistic regression. Secondary outcomes included TORS versus open surgical approach, and overall survival evaluated with Cox proportional hazards analysis.ResultsOf the 19,810 patients with cT1‐4, N0‐3, M0 HPV‐positive OPSCC included in this study, 4921 (24.8%) were treated at LBH, 12,201 (61.6%) were treated at MBH, and 2688 (13.6%) were treated at HBH. In multivariable‐adjusted analysis, compared with treatment at LBH, treatment at HBH was associated with more frequent radiation over surgical treatment (OR: 1.26, 95% CI: 1.12–1.40, p < 0.001). For patients undergoing surgery, patients at HBH had less frequent transoral robotic surgery (OR: 0.30, 95% CI 0.24–0.38, p < 0.001) compared with patients treated at LBH. Overall survival of patients treated at HBH was worse than that of patients treated at LBH (HR: 1.27, 95% CI 1.13–1.43, p < 0.001).ConclusionThese findings highlight underlying disparities at higher safety‐net burden facilities that impact patterns of care and outcomes for patients with OPSCC.Level of Evidence3 Laryngoscope, 2023

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The impact of distance to facility on treatment modality, short-term outcomes, and survival of patients with HPV-positive oropharyngeal squamous cell carcinoma

Vasan,

Gilja,

Kapustin

et al. 2024

American Journal of Otolaryngology

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The impact of socioeconomic and geographic factors on access to transoral robotic/endoscopic surgery for early stage oropharyngeal malignancy

Cited by 5 publications

References 16 publications

Are Social Determinants of Health Associated With Onset of Rehabilitation Services in Patients Hospitalized for Traumatic Brain Injury?

Are Social Determinants of Health Associated With Onset of Rehabilitation Services in Patients Hospitalized for Traumatic Brain Injury?

The Impact of Hospital Safety‐Net Burden Status on Patients with HPV‐Positive Oropharyngeal Cancer

The impact of distance to facility on treatment modality, short-term outcomes, and survival of patients with HPV-positive oropharyngeal squamous cell carcinoma

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