Vanderbilt University School of Medicine, Nashville, Tennessee.
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Laryngoscope. 2020 Apr;130(4):1000-1006. doi: 10.1002/lary.28208. Epub 2019 Jul 29.
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.
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.
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.
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 3, retrospective review comparing cases and controls Laryngoscope, 130:1000-1006, 2020.
健康的社会决定因素影响着广泛的健康结果和风险。迄今为止，尚无研究评估社会决定因素对喉气管狭窄（LTS）的影响。我们旨在描述一组 LTS 患者的社会决定因素，并探讨其与治疗结果的关系。
确定了 2013 年至 2018 年间接受手术治疗的 LTS 患者，并确定了 ICU 中接受超过 24 小时插管的患者作为匹配对照组。从临床记录中提取了医学合并症、狭窄特征和患者人口统计学数据。从病历和电话中记录了最后一次随访时的气管造口术情况。从美国社区调查中获得了社会经济数据。
122 例符合纳入标准。与田纳西州相比，病例的受教育程度明显较低（P =.009），但与 ICU 对照组的受教育程度相似。在调整分析中，与对照组相比，病例的体质指数（OR：1.04，P =.035）、插管时间（OR：1.21，P < .001）和吸烟（OR：1.21，P =.006）更高。在病例队列中，气管造口依赖与公共保险（OR：1.33，P =.016）和慢性阻塞性肺疾病（OR：1.34，P =.018）显著相关。
在 ICU 中，插管实践、医学合并症和健康的社会决定因素可能会影响 LTS 的发展和治疗后的气管造口依赖。在 ICU 中识别高危人群可能有助于通过早期气管造口术和专门的随访来预防气管造口依赖。
3 级，回顾性病例对照研究比较病例和对照组。喉镜，130：1000-1006，2020。
