Neighborhood Deprivation and Voice and Reflux Symptom Burden in a Tertiary Laryngology Cohort.

Abstract

The voice handicap index-10 (VHI-10) and reflux symptoms index (RSI) are validated, patient-reported outcome measures (PROMs) commonly used in laryngology to assess the subjective impact of voice disorders and severity of symptoms associated with laryngopharyngeal reflux, respectively. This study aims to evaluate the relationship between neighborhood-level socioeconomic disadvantage, as measured by the area deprivation index (ADI), and patient-reported laryngeal outcomes. An analysis of 1310 adult patients who were referred to a tertiary care laryngology clinic between January and December 2024 was conducted. Patient addresses were geocoded and matched to corresponding ADI national percentile scores, and internally derived ADI quartiles were formed. Median VHI-10 and RSI scores by ADI quartile were compared using the Kruskal-Wallis test. Multivariable linear regression was performed to investigate the association between ADI and VHI-10 or RSI scores, adjusting for sociodemographic (race, sex, and age) and clinical (comorbidities, depression/anxiety, insurance status, BMI, and primary diagnosis) factors. Patients living in the least deprived ADI quartile had significantly lower median VHI-10 and RSI Scores, compared to patients in the most deprived ADI quartile (10 vs. 14, and 15 vs. 20, respectively). In adjusted analysis, living in a higher ADI area was significantly associated with a higher VHI-10 (β = 0.04, 95% confidence interval [CI]: 0.008-0.06) or RSI (β = 0.04, 95% CI: 0.01-0.07) score. Higher neighborhood socioeconomic deprivation is significantly associated with higher VHI-10 and RSI scores. Patients living in more deprived areas may face barriers to accessing care, including low health literacy and limited resources.