The Relationship between Social Determinants of Health and Utilization of Tertiary Rhinology Care

Samuelson, M; Chandra, Rakesh K.; Turner, Justin H.; Russell, Paul T.; Francis, David O.

doi:10.2500/ajra.2017.31.4476

Cited by 25 publications

(42 citation statements)

References 24 publications

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“…The study of these social determinants, such as income, education, race, nutrition, and insurance is gaining momentum as a promising method to decrease the burden of disease and achieve health equity . Disparities in these factors have been documented in multiple otolaryngologic diseases, and several studies have employed zip code–based analysis to describe sociodemographic factors as well as geographic clustering of patients . A recent study utilizing zip code–based analysis demonstrated higher sociodemographic status patients have higher utilization rates for chronic rhinosinusitis treatment .…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7] A recent study utilizing zip code-based analysis demonstrated higher sociodemographic status patients have higher utilization rates for chronic rhinosinusitis treatment. 7 Despite the impact of social determinants of health on several otolaryngologic diseases, the study of these factors in laryngotracheal stenosis has not been explored.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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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

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…A recent study of health-care utilization showed females are more likely to seek treatment for CRS than males. 15 This finding is certainly an area that would need to be studied further to investigate the connection between male gender and neo-osteogenesis.…”

Section: Discussionmentioning

confidence: 97%

“…A total score >5 is positive for neoosteogenesis. This was classified into mild (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), moderate (21-35), or severe (>35). The interrater reliability for GOSS between the 2 reviewers was 0.77 (95% CI, 0.54-0.89) for the same 23 patients who were referenced with the LMS scoring.…”

Section: Radiologic Scoringmentioning

confidence: 99%

Risk factors for neo‐osteogenesis in cystic fibrosis and non‒cystic fibrosis chronic rhinosinusitis

Karempelis

Karp

Rubin

et al. 2019

Int Forum Allergy Rhinol

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Background:The purpose of this retrospective review was to determine how patient-related factors and culture data affect neo-osteogenesis in patients with chronic rhinosinusitis (CRS) and patients with cystic fibrosis (CF) with CRS. Methods:Information from a database associated with a large tertiary medical center was used to assess adult patients with CF CRS and non-CF CRS (total, n = 102; CF CRS, n = 31; non-CF CRS, n = 71). Radiologic evidence of neo-osteogenesis was measured using the Global Osteitis Scoring Scale (GOSS), and mucosal disease was assessed using the Lund-Mackay score (LMS) by 2 independent reviewers who were blinded to the patient's disease state. Bacterial cultures were obtained endoscopically. Multiple logistic regression models were used to evaluate the effect of age, sex, number of previous surgeries, CF, and culture species on the odds of neo-osteogenesis. Results:Fi y-one of the 102 patients (50%) met radiologic criteria for neo-osteogenesis. Sixty-nine patients (67.6%) with CF CRS and non-CF CRS had culture data. In the multiple logistic regression model, male gender was significantly associated with neo-osteogenesis (odds ratio [OR], 5.2; 95% confidence interval [CI], 1.68-17.86; p = 0.006). Pseudomonas aeruginosa was not associated with neoosteogenesis (OR, 3.12; 95% CI,; p = 0.097). Age, number of surgeries, CF, Staphylococcus aureus, and coagulase-negative Staphylococcus were not statistically significant. Conclusion:To our knowledge, this is the first study to assess risk factors associated with neo-osteogenesis and patients with CF CRS. Interestingly, male gender was the only significant predictor of neo-osteogenesis. C 2019 ARS-AAOA, LLC.

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“…In another study, Samuelson et al 18 reviewed the relationship between social determinants of health and the utilization of tertiary rhinology care in patients with CRS who sought care at Vanderbilt University. In their study of Ͼ1300 patients, they showed that increased age, white race, higher income, and college education were all associated with higher utilization of rhinology services.…”

Section: Alkis James Psaltis Mbbs (Hons) Phd Fracsmentioning

confidence: 99%

Beyond Borders and Sinuses: Rhinology and Allergy Research on a World Stage

Psaltis¹

2017

Am J Rhinol�Allergy

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Beyond borders and sinuses: Rhinology and allergy research on a world stage R esearch forms the keystone on which medicine is advanced. It improves our understanding of the disease process and paves the way for new treatment development. This journal prides itself on the publishing of well-performed basic science and clinical research. Its adherence to a rigorous peer-review process and the careful selection of diverse articles maintains its high quality and its relevance to the broad readership. This issue, in particular, exemplifies the international presence of American Journal of Rhinology & Allergy (AJRA), with as many articles from abroad as from local research groups. Basic science, translational, and clinical research articles from the United States, Europe, Asia, and the Middle East comprise this installment of the AJRA, with diverse topics to interest both clinicians and scientists. Novel biomarkers for predicting polyps status, topical therapy to improve nasal continuous positive airway pressure (CPAP) compliance, and the use of gels and/or stents to improve surgical outcomes are among the many interesting articles available to the reader.Inflammatory upper airway disorders remain among the most common chronic conditions that confront primary health care providers and otolaryngologists. Most recent estimates indicate that the overall cost of chronic rhinosinusitis (CRS) to the American population exceeds 20 billion dollars per year. 1 Although patients often look to surgery as a "cure" for their condition, most clinicians would agree that the main role of surgery is to reduce the inflammatory burden and improve the access of the sinuses to topical medications. It is not until the complex inflammatory pathways are completely discerned that a "cure" will ever be achievable. An important step forward toward this requires an understanding of the pathophysiology at an immunologic level. The relatively recent discovery of the regulatory T cells and their role in CRS was a significant breakthrough. These cells seem to play a central immunomodulatory role in inflammatory nasal disease and may hold the key to controlling the dysregulated inflammation seen in these conditions.In this issue of the AJRA, Palmer et al., 2 provided a comprehensive review of the role of regulatory T cells in upper airways inflammation and identified current deficiencies in our understanding of their function. Defective cytotoxic T-cell function has similarly also been implicated in the dysregulated immune response seen in CRS. 3 A novel study by Smith et al., 4 also published in this issue, set out to explore the mechanism behind this. In their study of patients with CRS with and without polyps, the investigators observed a decrease in the local production of the important cytotoxic T-cell mediators, granzyme B, and perforin, despite an increase in absolute cytotoxic T-cell numbers in the tissue of patients with CRS. 4 They postulated that it is possible that this deficiency may affect antiviral immunity and predispose patients with ...

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The Relationship between Social Determinants of Health and Utilization of Tertiary Rhinology Care

Cited by 25 publications

References 24 publications

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

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

Risk factors for neo‐osteogenesis in cystic fibrosis and non‒cystic fibrosis chronic rhinosinusitis

Beyond Borders and Sinuses: Rhinology and Allergy Research on a World Stage

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