Treatment Receipt and Outcomes of Self‐Reported Voice Problems in the US Population Aged ≥65 Years

Abstract

Objectives(1) Characterize the US population aged ≥65 years with self-reported voice problems, (2) describe voice treatment characteristics in this group, and (3) identify factors associated with self-reported voice improvement.Study DesignRetrospective cohort study.SettingPopulation-based cross-sectional US national survey sample.Subjects and MethodsWe identified a cohort of adults aged ≥65 years from the 2012 National Health Interview Survey, a population-based US national survey. Descriptive and multivariable regression analyses were performed.ResultsThe prevalence of self-reported voice problems in this cohort was 10%. Of those, 44% reported voice problems for >1 month. The strongest predictor of reporting voice improvement was receipt of voice treatment (odds ratio, 3.50; 95% confidence interval, 1.36-9.00), after adjusting for sex, age, race, education, and health status. Eleven percent reported voice treatment, which included 20% of those with moderate or worse voice problem severity. Female sex and worse health status were associated with reporting voice treatment. Among those with voice treatment, 38% reported “better,” 33% “same,” and 29% “worse” voice symptoms over the past year, compared to 17%, 67%, and 16%, respectively, among those without treatment. Health status influenced likelihood of reporting voice improvement but not universally.ConclusionsWe observed a significant self-reported burden of voice problems in the US population aged ≥65 years. Most are untreated and thus not well represented in the current literature. Vocal improvement was strongly associated with treatment. Further investigation is needed to clarify patient and treatment characteristics most associated with vocal improvement.

Association of Visit Volume and Sociodemographic Characteristics With Vocal Improvement Among Older US Adults With a Self-reported Voice Problem

“…3 Self-reported presence of voice problems and subsequent improvement was assessed via NHIS. 1 Two-year Evaluation and Management visit volume intensity with Clinical Provider Specialty Codes were extracted from Medicare claims (eTable in Supplement 1). We used 1 year of prior fee-for-service utilization data with the 2012 NHIS survey data to capture current and past utilization by Medicare beneficiaries.…”

Healthcare Disparities in Laryngology: A Scoping Review

“…2A,B). Sex and gender‐related disparities included men being less likely to report voice disorders, 57,58 men being less likely to report receiving treatment for a voice disorder, 55 and women being less likely to be referred to otolaryngology for voice disorders 60 . In a retrospective review of 149,653 patients visiting a primary care physician with a laryngeal/voice disorder, female patients had a hazard ratio of 0.78 (95% CI 0.74–0.81, P < .001) for being referred to an otolaryngologist compared to male patients 60 .…”

“…57,58 Males less likely to report receiving treatment for voice disorder (OR 0.36, 95% CI 0.16-0.79). 55 Females less likely to be referred to otolaryngology (HR 0.78, 95% CI 0.74-0.81, P < .001). 60 Lower expenditures for females in cohort with range of laryngeal disorders (coefficient,$ -97, 95% CI −107 to −88, P < .001).…”

“…Higher education level associated with improvement in voice symptoms. 55,56 Geography Midwesterners more likely to report voice disorders. 57,58 For patients undergoing procedures on same day as dysphonia diagnosis, higher expenditures in South (coefficient,$ 22, 95% CI 12 to 32, P < .001) and Northeast (reference) vs. West (coefficient,$ -17, 95% CI -29 to −6, P < .003) and North-Central (coefficient,$ -16, 95% CI -26 to −5, P = .005) regions.…”

The Demographics of Patients Presenting for Laryngological Care at an Academic Medical Center

“…Health disparities among patients with voice, 7–13 swallowing, 14–19 or airway concerns 20 have been described in the literature. These articles served to identify the impact of race/ethnicity, sex/gender, and various socioeconomic factors in relation to their burden of disease, access to care, offered treatment modalities, and outcomes.…”