The impact of social determinants of health on laryngotracheal stenosis development and outcomes.
The impact of social determinants of health on laryngotracheal stenosis development and outcomes.
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DOI：
10.1002/lary.28208
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发表时间：
2020-04
期刊：
影响因子：
--
通讯作者：
Gelbard A
中科院分区：
文献类型：
--
作者：
Dang S;Shinn JR;Campbell BR;Garrett G;Wootten C;Gelbard A
健康的社会决定因素影响到广泛的健康结果和风险。到目前为止，还没有研究评估健康的社会决定因素对喉气管狭窄（LTS）的影响。我们试图描述LTS患者队列中的社会决定因素，并探讨其与治疗结果的关系。确定了2013- 2018年期间接受外科手术的LTS诊断受试者。从接受插管超过24小时的重症监护室（ICU）患者中确定匹配的对照组。从临床记录中提取医学共病、狭窄特征和患者人口统计学资料。根据病历和电话记录末次随访时的气管切开术。社会经济数据来自美国社区调查。122例病例符合入选标准。与田纳西州相比，病例的受教育程度明显较低（p=0.009），但与ICU对照组的受教育程度相似。在校正分析中，与对照组相比，病例的体重指数（OR：1.04，p=0.035）、插管持续时间（OR：1.21，p<0.001）和烟草使用（OR：1.21，p=0.006）显著更高。在调整分析中，病例队列中的气管切开依赖性与公共保险（OR：1.33，p=0.016）和慢性阻塞性肺疾病（OR：1.34，p=0.018）显著相关。插管实践，医疗共病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切开术依赖。识别ICU中的高危人群可能有助于通过早期气管切开术和专业随访来预防气管切开术依赖。
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– 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. 122 cases met inclusion criteria. Cases had significantly lower education compared to Tennessee (p=0.009) but similar education rates as ICU controls. Cases had significantly higher body mass index (OR: 1.04, p=0.035), duration of intubation (OR: 1.21, p<0.001), and tobacco use (OR: 1.21, p=0.006) in adjusted analysis when compared to controls. Tracheostomy dependence within the case cohort was significantly associated with public insurance (OR:1.33, p=0.016) and chronic obstructive pulmonary disease (OR: 1.34, p=0.018) 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.
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DOI：
10.1001/jama.2016.4226
发表时间：
2016-04-26
期刊：
JAMA
影响因子：
--
作者：
Chetty R;Stepner M;Abraham S;Lin S;Scuderi B;Turner N;Bergeron A;Cutler D
通讯作者：
Cutler D
DOI：
10.1177/0194599818800462
发表时间：
2018-12
期刊：
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
影响因子：
--
作者：
Gadkaree SK;Gelbard A;Best SR;Akst LM;Brodsky M;Hillel AT
通讯作者：
Hillel AT
影响因子：
1.3
作者：
Borschuk, Adrienne P.;Everhart, Robin S.
通讯作者：
Everhart, Robin S.
影响因子：
1.9
作者：
Bergmark RW;Sedaghat AR
通讯作者：
Sedaghat AR
DOI：
10.1177/0003489415608867
发表时间：
2016-03
期刊：
The Annals of otology, rhinology, and laryngology
影响因子：
--
作者：
Hillel AT;Karatayli-Ozgursoy S;Samad I;Best SR;Pandian V;Giraldez L;Gross J;Wootten C;Gelbard A;Akst LM;Johns MM;North American Airway Collaborative (NoAAC)
通讯作者：
North American Airway Collaborative (NoAAC)