Healthcare disparities for the development of airway stenosis from the medical intensive care unit

Abstract

Objectives/hypothesis To identify sociodemographic factors associated with the development of airway stenosis (AS) among intubated medical intensive care unit (MICU) patients. Study design Retrospective cohort study. Methods A retrospective review of adult MICU intubated patients from 2013 to 2019 at a single academic institution was performed. Univariate and multivariate analysis with logistic regression examined associations between the development of AS and subsite abnormalities such as posterior glottic stenosis (PGS), subglottic stenosis (SGS), tracheal stenosis (TS), vocal fold immobility (VFI), and posterior glottic granuloma (PGG) with age, body mass index (BMI), height, weight, race, ethnicity, sex, rurality, Appalachian status, length of admission, distance to hospital, and median household income. Results Of an overall sample of 6603 MICU patients, 449 intubated patients were included in the study, and 204 patients were found to have AS. AS was statistically associated with decreased driving distance to the hospital and increases in BMI. PGS was statistically associated with increases in age. TS was statistically associated with increases in admission duration and not having residence status in Appalachia. VFI was statistically associated with decreases in driving distance to the hospital and not having residence status in Appalachia. Additionally, black patients had a higher odds of developing VFI compared to Caucasian patients. Conclusion AS is associated with sociodemographic factors such as age, BMI, shorter distance to hospital, admission duration, and no Appalachian status. These data demonstrate the need to further investigate the impact of social determinants of health on airway pathology and outcomes. Level of evidence 4.

Geospatial evaluation of access to otolaryngology care in the United States

“…Counterintuitive consequences including the "referral bias" or "distance bias," which describe those patients who travel farther for care are more likely to achieve more favorable outcomes, have been investigated across various fields of medicine including in otolaryngology. [15][16][17] Higher costs, outdated methodology, less peer influence, and poor practice efficiency are just some of the numerous factors confounding a purely physical explanation to healthcare outcomes. 18 Our study revealed that compared with regions with high accessibility, regions of low ATOC were less population dense counties.…”

“…The effect of physical access upon otolaryngology care has been a topic of debate in literature. Counterintuitive consequences including the “referral bias” or “distance bias,” which describe those patients who travel farther for care are more likely to achieve more favorable outcomes, have been investigated across various fields of medicine including in otolaryngology 15–17 . Higher costs, outdated methodology, less peer influence, and poor practice efficiency are just some of the numerous factors confounding a purely physical explanation to healthcare outcomes 18…”

Risk factors for developing subglottic and tracheal stenosis from the medical intensive care unit

“…However, this information may be used to inform clinical decision making and guide more rigorous studies in the future. Additionally, given the single‐institution nature of this study, patients may have presented to outside facilities for follow‐up or they may have been lost to follow‐up due to barriers to care such as distance to hospital 13 . Therefore, the reported incidence of SGS and TS may be an underestimate.…”

Sociodemographic Disparities in Tracheostomy Timing and Outcomes

“…31 Finally, the development of airway stenosis following intubation, which is correlated with the duration of intubation, has also been associated with social determinants of health, including public insurance status, race, and region of residence. 32,33 Care standardization and algorithmic decisionmaking have been associated with reduced disparities by improving overall health outcomes and decreasing differential management. 34,35 For example, in the field of obstetrics, standardized induction of labor protocols may reduce racial disparities in birth outcomes, including c-section rates and neonatal morbidity.…”

“…Although they did not analyze the effect of language on tracheostomy timing, minority racial/ethnic background may also correlate with limited English proficiency 31 . Finally, the development of airway stenosis following intubation, which is correlated with the duration of intubation, has also been associated with social determinants of health, including public insurance status, race, and region of residence 32,33 …”