Mormer Elizabeth, Terhorst Lauren, Coyle James, Freburger Janet
Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA.
Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA.
Am J Speech Lang Pathol. 2024 Sep 6:1-11. doi: 10.1044/2024_AJSLP-24-00024.
Disparities in health care utilization are modifiable drivers of disparities in health outcomes but have not been explored regarding speech-language pathology utilization for patients with dysphagia. This study explores racial and ethnic disparities in the utilization of speech-language pathology services among adult patients diagnosed with oropharyngeal dysphagia during acute care hospitalizations.
We analyzed New York State Inpatient Data on acute care hospitalizations in 2019. We identified adults with a diagnosis of oropharyngeal dysphagia and determined whether they received speech-language pathology services via revenue center codes, which indicate receipt of a speech-language pathology evaluation or treatment. Using generalized estimating equations, we estimated the effect of race/ethnicity (White, Black, Hispanic, and Other race) on speech-language pathology utilization (yes, no) during the acute care hospitalization, controlling for patient clinical characteristics (e.g., acute diagnoses and clinical comorbidities), demographic characteristics (e.g., insurance status, rural-urban status), and health system factors (e.g., hospital size). Subgroup analyses were conducted for select primary diagnoses (i.e., stroke, sepsis, and aspiration pneumonia).
We identified 56,198 individuals with a diagnosis of oropharyngeal dysphagia; 60.7% received speech-language pathology services. In the full sample analysis, the adjusted odds of speech-language pathology utilization were lower in Black relative to White individuals (odds ratio [] = 0.87 [0.76, 0.98], = .026). Racial and ethnic disparities were present in the subgroup analyses, most notably for sepsis, where speech-language pathology utilization was significantly lower for Black, Hispanic, and Other race individuals (s from 0.61 to 0.77) relative to White individuals.
We found evidence of racial and ethnic disparities in the utilization of speech-language pathology services for patients with oropharyngeal dysphagia in the acute care setting that varied by primary diagnosis. Further research is needed to replicate these findings and to begin to understand the reasons behind these disparities.
医疗保健利用方面的差异是健康结果差异的可改变驱动因素，但对于吞咽困难患者的言语病理学利用情况尚未进行探讨。本研究探讨了在急性护理住院期间被诊断为口咽吞咽困难的成年患者在言语病理学服务利用方面的种族和民族差异。
我们分析了2019年纽约州急性护理住院患者的数据。我们确定了诊断为口咽吞咽困难的成年人，并通过收入中心代码确定他们是否接受了言语病理学服务，这些代码表明接受了言语病理学评估或治疗。使用广义估计方程，我们估计了种族/民族（白人、黑人、西班牙裔和其他种族）对急性护理住院期间言语病理学利用情况（是、否）的影响，并控制了患者的临床特征（如急性诊断和临床合并症）、人口统计学特征（如保险状况、城乡状况）和卫生系统因素（如医院规模）。对选定的主要诊断（即中风、败血症和吸入性肺炎）进行了亚组分析。
我们确定了56198名诊断为口咽吞咽困难的个体；60.7%接受了言语病理学服务。在全样本分析中，黑人相对于白人接受言语病理学服务的调整后几率较低（优势比[]=0.87[0.76，0.98]，P=.026）。亚组分析中存在种族和民族差异，最明显的是败血症，黑人、西班牙裔和其他种族个体的言语病理学利用率（范围从0.61到0.77）相对于白人个体显著较低。
我们发现，在急性护理环境中，口咽吞咽困难患者在言语病理学服务利用方面存在种族和民族差异，且因主要诊断而异。需要进一步的研究来重复这些发现，并开始了解这些差异背后的原因。
