Shires Courtney B, Bui Roger, Bocklud Brooke, Dewan Karuna
West Cancer Center, Germantown, TN, USA.
Department of Otolaryngology-Head and Neck Surgery, Louisiana State University-Shreveport, Shreveport, LA, USA.
Am J Otolaryngol. 2025 Sep-Oct;46(5):104718. doi: 10.1016/j.amjoto.2025.104718. Epub 2025 Aug 5.
There is currently a paucity of literature detailing the socioeconomic implications on management and outcomes of pediatric subglottic stenosis. Through this study, we sought to ascertain whether disparities of social determinants of health did have a discernible impact on management of subglottic stenosis through endoscopic versus open procedures and whether there would be a difference in outcomes.
The study is a multi- institutional, academic center, retrospective case series.
The study examines pediatric patients under the age of 18 evaluated by Ochsner-affiliated hospitals through May 2012 to May 2022 with the diagnosis of subglottic stenosis, acquired or congenital, through Epic SlicerDicer search engine. Patients were stratified into low and high socioeconomic status (SES), which served as independent variables, using principal component analysis of several social determinants. We recorded sex, age, ethnicity, and completion of college education. Interventions reviewed included endoscopic treatment, open airway surgery, and presence of tracheostomy. Outcome measurements included decannulation, time to decannulation, and death. Chi squared analysis was performed on dichotomous variables and student t-test was performed for continuous variables.
The groups were similar in demographics: sex, age, ethnicity, and proportion with college degree. Cotton Meyer grade was significantly higher in low SES compared to high SES (p = 0.04). Patients of low SES were significantly more likely to die (p < 0.001). Low SES patients were more likely to have an acquired rather than a congenital subglottic stenosis as compared to their high SES counterparts (p = 0.02). Low SES patients were also more likely to undergo endoscopic intervention (p = 0.03). There was no statistically significant difference in tracheostomy status or decannulation success between the two groups.
There were statistically significant findings between low and high SES groups. Overall, patients of low SES appeared to have greater severity of subglottic stenosis, with greater number of endoscopic interventions, and greater mortality. This study which collected data from an area with marginalized patients with poor health literacy, demonstrates that sociodemographic factors contribute to disparate intervention and outcomes in pediatric patients with subglottic stenosis.
目前鲜有文献详细阐述社会经济因素对小儿声门下狭窄治疗及预后的影响。通过本研究，我们试图确定健康的社会决定因素差异是否确实会对声门下狭窄的内镜治疗与开放手术的治疗方式产生显著影响，以及预后是否会存在差异。
本研究是一项多机构学术中心的回顾性病例系列研究。
本研究通过Epic SlicerDicer搜索引擎，对2012年5月至2022年5月期间在奥施纳附属医院接受评估的18岁以下诊断为后天性或先天性声门下狭窄的儿科患者进行了研究。使用几个社会决定因素的主成分分析，将患者分为社会经济地位（SES）低和高两组，作为自变量。我们记录了性别、年龄、种族和大学教育完成情况。回顾的干预措施包括内镜治疗、气道开放手术和气管造口术。结局指标包括拔管、拔管时间和死亡情况。对二分变量进行卡方分析，对连续变量进行学生t检验。
两组在人口统计学特征上相似：性别、年龄、种族和大学学历比例。与高SES组相比，低SES组的科顿·迈耶分级显著更高（p = 0.04）。低SES患者死亡的可能性显著更高（p < 0.001）。与高SES患者相比，低SES患者更有可能患后天性而非先天性声门下狭窄（p = 0.02）。低SES患者也更有可能接受内镜干预（p = 0.03）。两组在气管造口状态或拔管成功率方面没有统计学上的显著差异。
低SES组和高SES组之间存在统计学上的显著差异。总体而言，低SES患者的声门下狭窄似乎更严重，内镜干预次数更多，死亡率更高。这项从健康素养较差的边缘化患者地区收集数据的研究表明，社会人口学因素导致小儿声门下狭窄患者的干预措施和预后存在差异。
