TY - JOUR
T1 - The impact of social determinants of health on laryngotracheal stenosis development and outcomes
AU - Dang, Sabina
AU - Shinn, Justin R.
AU - Campbell, Benjamin R.
AU - Garrett, Gaelyn
AU - Wootten, Christopher
AU - Gelbard, Alexander
N1 - Publisher Copyright:
© 2019 The American Laryngological, Rhinological and Otological Society, Inc.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - 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.
AB - 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.
KW - Social determinants of health
KW - endotracheal intubation
KW - intensive care unit
KW - laryngotracheal stenosis
KW - tracheostomy dependence
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U2 - 10.1002/lary.28208
DO - 10.1002/lary.28208
M3 - Article
C2 - 31355958
AN - SCOPUS:85070450637
SN - 0023-852X
VL - 130
SP - 1000
EP - 1006
JO - Laryngoscope
JF - Laryngoscope
IS - 4
ER -