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

Dang S, Shinn JR, Campbell BR, Garrett G, Wootten C, Gelbard A
Laryngoscope. 2020 130 (4): 1000-1006

PMID: 31355958 · DOI:10.1002/lary.28208

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.

© 2019 The American Laryngological, Rhinological and Otological Society, Inc.

MeSH Terms (18)

Adult Aged Aged, 80 and over Critical Care Female Follow-Up Studies Humans Laryngoscopy Laryngostenosis Male Middle Aged Retrospective Studies Risk Factors Social Determinants of Health Time Factors Tracheal Stenosis Treatment Outcome Young Adult

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