Association of Social Determinants of Health with Time to Diagnosis and Treatment Outcomes in Idiopathic Subglottic Stenosis

Jaclyn Lee¹, Li-Ching Huang², Lynn D Berry², Catherine Anderson³, Milan R Amin⁴, Michael S Benninger⁵, Joel H Blumin⁶, Jonathan M Bock⁶, Paul C Bryson⁵, Paul F Castellanos⁷, Sheau-Chiann Chen², Matthew S Clary⁸, Seth M Cohen⁹, Brianna K Crawley¹⁰, Seth H Dailey¹⁰, James J Daniero¹¹, Alessandro de Alarcon¹², Donald T Donovan¹³, Eric S Edell¹⁴, Dale C Ekbom¹⁵, Daniel S Fink⁸, Ramon A Franco¹⁶, C Gaelyn Garrett¹, Elizabeth A Guardiani¹⁷, Alexander T Hillel¹⁸, Henry T Hoffman¹⁹, Norman D Hogikyan²⁰, Rebecca J Howell¹², Lena K Hussain², Michael M Johns²¹, Jan L Kasperbauer¹⁵, Sid M Khosla¹², Cheryl Kinnard², Robbi A Kupfer²⁰, Alexander J Langerman², Robert J Lentz², Robert R Lorenz⁶, David G Lott²², Anne S Lowery¹, Samir S Makani²³, Fabien Maldonado¹, Kyle Mannion¹, Laura Matrka²⁴, Andrew J McWhorter²⁵, Albert L Merati²⁶, Matthew Mori²⁷, James L Netterville¹, Karla O'Dell²¹, Julina Ongkasuwan¹³, Gregory N Postma²⁸, Lindsay S Reder²¹, Sarah L Rohde¹, Brent E Richardson²⁹, Otis B Rickman³⁰, Clark A Rosen³¹, Michael J Rutter¹², Guri S Sandhu³², Joshua S Schindler³³, G Todd Schneider³⁴, Rupali N Shah³⁵, Andrew G Sikora¹³, Robert J Sinard¹, Marshall E Smith³⁶, Libby J Smith³⁷, Ahmed M S Soliman³⁸, Sigríður Sveinsdóttir³⁹, Douglas J Van Daele¹⁹, David Veivers⁴⁰, Sunil P Verma⁴¹, Paul M Weinberger⁴², Philip A Weissbrod⁴³, Christopher T Wootten¹, Yu Shyr², David O Francis⁴⁴, Alexander Gelbard¹

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
² Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA.
³ Australian Market and Social Research Society, Glebe, NSW, Australia.
⁴ NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, USA.
⁵ Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA.
⁶ Division of Laryngology and Professional Voice, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA.
⁷ Division of Otolaryngology, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
⁸ Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Denver, CO, USA.
⁹ Duke Voice Care Center, Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, NC, USA.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, CA, USA.
¹¹ Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA, USA.
¹² Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, USA.
¹³ Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.
¹⁴ Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
¹⁵ Department of Otolaryngology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
¹⁶ Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
¹⁷ Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
¹⁸ Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institution, Baltimore, MD, USA.
¹⁹ Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
²⁰ Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA.
²¹ Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, USA.
²² Department of Otorhinolaryngology, Mayo Clinic Scottsdale, Scottsdale, AZ, USA.
²³ Division of Pulmonary and Critical Care Medicine, University of California, San Diego, San Diego, CA, USA.
²⁴ Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Medical Center, Columbus, OH, USA.
²⁵ Department of Otolaryngology, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA, USA.
²⁶ Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, WA, USA.
²⁷ Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY USA.
²⁸ Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA.
²⁹ Bastian Voice Institute, Downers Grove, IL, USA.
³⁰ Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
³¹ Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA.
³² National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
³³ Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Northwest Clinic for Voice and Swallowing, Portland, OR, USA.
³⁴ Department of Otolaryngology, University of Rochester, Rochester, NY, USA.
³⁵ Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
³⁶ Division of Otolaryngology-Head and Neck Surgery, The University of Utah, Salt Lake City, UT, USA.
³⁷ Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
³⁸ Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
³⁹ Landspítali University Hospital, Reykjavik, Iceland.
⁴⁰ Department of Otolaryngology-Head and Neck Surgery, Royal North Shore Hospital, Sydney, NSW, Australia.
⁴¹ Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA.
⁴² Departments of Otolaryngology, Molecular and Cellular Physiology, Feist-Weiller Cancer Center, LSU Shreveport, LA, USA.
⁴³ Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, San Diego, CA, USA.
⁴⁴ Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, Madison, WI, USA.

PMID: 33629608
PMCID: PMC8762607
DOI: 10.1177/0003489421995283

Association of Social Determinants of Health with Time to Diagnosis and Treatment Outcomes in Idiopathic Subglottic Stenosis

Jaclyn Lee et al. Ann Otol Rhinol Laryngol. 2021 Oct.

. 2021 Oct;130(10):1116-1124.

doi: 10.1177/0003489421995283. Epub 2021 Feb 25.

Authors

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
² Vanderbilt Center for Quantitative Sciences, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA.
³ Australian Market and Social Research Society, Glebe, NSW, Australia.
⁴ NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, USA.
⁵ Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA.
⁶ Division of Laryngology and Professional Voice, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA.
⁷ Division of Otolaryngology, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
⁸ Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Denver, CO, USA.
⁹ Duke Voice Care Center, Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, NC, USA.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, CA, USA.
¹¹ Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA, USA.
¹² Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, USA.
¹³ Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.
¹⁴ Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
¹⁵ Department of Otolaryngology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
¹⁶ Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
¹⁷ Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
¹⁸ Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institution, Baltimore, MD, USA.
¹⁹ Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
²⁰ Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA.
²¹ Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, USA.
²² Department of Otorhinolaryngology, Mayo Clinic Scottsdale, Scottsdale, AZ, USA.
²³ Division of Pulmonary and Critical Care Medicine, University of California, San Diego, San Diego, CA, USA.
²⁴ Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Medical Center, Columbus, OH, USA.
²⁵ Department of Otolaryngology, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA, USA.
²⁶ Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, Seattle, WA, USA.
²⁷ Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY USA.
²⁸ Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA.
²⁹ Bastian Voice Institute, Downers Grove, IL, USA.
³⁰ Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
³¹ Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA.
³² National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
³³ Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Northwest Clinic for Voice and Swallowing, Portland, OR, USA.
³⁴ Department of Otolaryngology, University of Rochester, Rochester, NY, USA.
³⁵ Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
³⁶ Division of Otolaryngology-Head and Neck Surgery, The University of Utah, Salt Lake City, UT, USA.
³⁷ Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
³⁸ Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
³⁹ Landspítali University Hospital, Reykjavik, Iceland.
⁴⁰ Department of Otolaryngology-Head and Neck Surgery, Royal North Shore Hospital, Sydney, NSW, Australia.
⁴¹ Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, CA, USA.
⁴² Departments of Otolaryngology, Molecular and Cellular Physiology, Feist-Weiller Cancer Center, LSU Shreveport, LA, USA.
⁴³ Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, San Diego, CA, USA.
⁴⁴ Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, Madison, WI, USA.

PMID: 33629608
PMCID: PMC8762607
DOI: 10.1177/0003489421995283

Abstract

Objectives: To examine whether social determinants of health (SDH) factors are associated with time to diagnosis, treatment selection, and time to recurrent surgical intervention in idiopathic subglottic stenosis (iSGS) patients.

Methods: Adult patients with diagnosed iSGS were recruited prospectively (2015-2017) via clinical providers as part of the North American Airway Collaborative (NoAAC) and via an online iSGS support community on Facebook. Patient-specific SDH factors included highest educational attainment (self-reported), median household income (matched from home zip code via U.S. Census data), and number of close friends (self-reported) as a measure of social support. Main outcomes of interest were time to disease diagnosis (years from symptom onset), treatment selection (endoscopic dilation [ED] vs cricotracheal resection [CTR] vs endoscopic resection with adjuvant medical therapy [ERMT]), and time to recurrent surgical intervention (number of days from initial surgical procedure) as a surrogate for disease recurrence.

Results: The total 810 participants were 98.5% female, 97.2% Caucasian, and had a median age of 50 years (IQR, 43-58). The cohort had a median household income of $62 307 (IQR, $50 345-$79 773), a median of 7 close friends (IQR, 4-10), and 64.7% of patients completed college or graduate school. Education, income, and number of friends were not associated with time to diagnosis via multivariable linear regression modeling. Univariable multinominal logistic regression demonstrated an association between education and income for selecting ED versus ERMT, but no associations were noted for CTR. No associations were noted for time to recurrent surgical procedure via Kaplan Meier modeling and Cox proportional hazards regression.

Conclusions: Patient education, income, and social support were not associated with time to diagnosis or time to disease recurrence. This suggests additional patient, procedure, or disease-specific factors contribute to the observed variations in iSGS surgical outcomes.

Keywords: education; iSGS; income; social support; surgical outcomes; time to diagnosis.

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Conflict of interest statement

Conflicts of Interest Disclosures: None.

Figures

**Figure 1.**
Association of SDH factors and Time to Diagnosis. Multivariable linear regression of income, education, and social support to time to diagnosis (in patients with available data, N=578), controlling for patient age, time spent on social media, and treatment type. Triangles represent effect size, and bars represent 95% confidence intervals. Q1: first quartile; Q3: third quartile.

**Figure 2.**
Kaplan-Meier analysis of Median Household Income on time to recurrent surgical procedure in ED-treatment group. Percentage of patients avoiding recurrent procedures are stratified by income quartiles.

**Figure 3.**
Kaplan-Meier analysis of patient education on time to recurrent surgical procedure in ED-treatment group. Percentage of patients avoiding recurrent procedures are categorized by highest level of education.

**Figure 4.**
Kaplan-Meier analysis of social support on time to recurrent surgical procedure in ED-treatment group. Percentage of patients avoiding recurrent procedures are stratified by quartiles of number of close friends.

See this image and copyright information in PMC

References

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1. Idiopathic Subglottic Stenosis. Rare Disease Database. https://rarediseases.org/rare-diseases/idiopathic-subglottic-stenosis. Updated 2018. Accessed April 21, 2020.
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Association of Social Determinants of Health with Time to Diagnosis and Treatment Outcomes in Idiopathic Subglottic Stenosis

Affiliations

Association of Social Determinants of Health with Time to Diagnosis and Treatment Outcomes in Idiopathic Subglottic Stenosis

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources