The Relationship Between Social Determinants of Health and Cholesteatoma Care.

OBJECTIVE

To explore the associations between social determinants of health (SDOH) and the access to, delivery of, and outcomes of cholesteatoma care.

STUDY DESIGN

Retrospective review.

SETTING

Multisite tertiary care institution.

METHODS

Seventy-five adults (aged 18-83) with cholesteatoma who completed SDOH questionnaires were included. Outcome measures included SDOH risk factor prevalence (stress, housing instability, financial resource strain, social connectedness, food insecurity, intimate partner violence), disease severity, hearing loss degree at presentation, mean time from symptom onset to diagnosis, postoperative improvements in air-bone gaps (ABG), complication rates, and two-stage surgery rates.

RESULTS

Stress (n = 45; 60%) was the most prevalent SDOH risk factor. Females (n = 23; 79.3%; = 0.05; d = -0.24]), younger adults (mean age = 45; = 0.01; d = -0.69), and individuals with lower education (n = 23; 82.1%; = 0.04; d= -0.26) were more likely to have at least one SDOH risk factor. Patients with SDOH risk factors had better preoperative air pure tone averages (mean [SD] = 39.7 [16]; = 0.01; d = -0.69) than patients without SDOH risk factors (mean [SD] = 50.1 [13.5]); but the ABG was similar between groups ( = 0.16; d = -0.38). No differences were identified in any measure of cholesteatoma care between patients with and without SDOH risk factors.

CONCLUSION

Stress is a prevalent SDOH risk factor among patients with cholesteatoma, but it might not influence cholesteatoma care. Though female sex, younger age, and lower education levels were associated with having at least one SDOH risk factor, these also might not influence cholesteatoma care. Intentional study of larger, more heterogeneous populations is necessary to validate these observations.