Affiliation:
1. Department of Otolaryngology‐Head and Neck Surgery University of Miami Hospital Miami Florida U.S.A.
2. Herbert Wertheim College of Medicine, Florida International University Miami Florida U.S.A.
3. University of Miami School of Medicine Miami Florida U.S.A.
4. Division of Biostatistics, Department of Public Health Science University of Miami Miller School of Medicine Miami Florida U.S.A.
Abstract
ObjectiveTo determine the association of social determinants of health (SDOH) on the presentation and management of unilateral vocal fold immobility (UVFI).MethodsRetrospective chart review of 207 adult UVFI patients evaluated at a tertiary‐care hospital between 2018 and 2019 was performed. Sociodemographic factors including gender, median household income, preferred language, and insurance type were recorded. Confounding clinical factors including etiology of UVFI, Voice Handicap Index‐10 (VHI‐10) score, laryngoscopic findings, and intervention history were extracted from medical records. Multivariable logistic regression was performed using sociodemographic and clinical factors.ResultsPatient demographics and socioeconomic status were not associated with time to presentation. Patients presenting with glottic insufficiency and UVFI due to malignancy or recurrent laryngeal nerve (RLN) sacrifice had a shorter time to presentation. Higher household income was associated with greater number of interventions (p = 0.02), but neither income nor insurance type affected intervention type or timing. Female patients were less likely to undergo injection medialization laryngoplasty (odds ratio [OR] 0.25, p = 0.005). Older patients were more likely to undergo injection (OR 1.04, p = 0.027). Patients with large glottic gaps (OR 21.2, p = 0.014) and higher VHI‐10 scores (OR 1.06, p = 0.047) were more likely to undergo surgery.ConclusionHigher household income was associated with greater number of interventions and longer duration of care at a private tertiary‐care hospital. RLN sacrifice, known malignancy, and glottic insufficiency significantly reduced the time to presentation. Type of intervention received was a complex interplay of both demographic and clinical factors. Large prospective studies should examine the role of SDOH in the presentation and management of UVFI.Level of Evidence4 Laryngoscope, 134:297–304, 2024