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The impact of social determinants of health on laryngotracheal stenosis development and outcomes
Author(s) -
Dang Sabina,
Shinn Justin R.,
Campbell Benjamin R.,
Garrett Gaelyn,
Wootten Christopher,
Gelbard Alexander
Publication year - 2020
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.28208
Subject(s) - medicine , intubation , cohort , odds ratio , medical record , socioeconomic status , social determinants of health , intensive care unit , emergency medicine , public health , surgery , environmental health , population , nursing
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