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OBJECTIVES: To determine whether limited English proficiency (LEP) is associated with likelihood of prior audiogram and hearing aid use among US adults with hearing loss. METHODS: This cross-sectional study of four merged National Health and Nutrition Examination Survey (NHANES) cycles included 12,636 adults with subjective (self-reported) or objective (audiometric) hearing loss. Subjects were classified as LEP if they completed the NHANES survey in a language other than English, or with the help of an interpreter. Likelihood of audiogram among participants with subjective and objective hearing loss, and likelihood of hearing aid use among participants with objective hearing loss were assessed using unadjusted and adjusted logistic regression. RESULTS: Individuals with LEP were less likely to have undergone audiogram among subjects with subjective (odds ratio [OR] 0.72, 95% confidence interval [CI] 0.67-0.77), and objective (OR 0.70, 95% CI 0.65-0.74) hearing loss. The association persisted for those with subjective hearing loss (OR 0.79, 95% CI 0.72-0.86), and objective hearing loss (OR 0.81, 95% CI 0.73-0.89) after adjusting for relevant covariates. Individuals with LEP were less likely to use hearing aids (OR 0.88, 95% CI 0.84-0.93). This association disappeared (OR 0.99, 95% CI 0.95-1.04) after adjustment. CONCLUSION: LEP is associated with lower utilization of hearing healthcare services. This may be due to the complex interplay of socioeconomic and language disparities, which may act as barriers to hearing healthcare utilization. Individuals with LEP should be prioritized when designing interventions to improve accessibility to hearing healthcare. LEVEL OF EVIDENCE: Level 3 Laryngoscope, 2024.
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The COVID-19 pandemic caused major disruptions to healthcare services in 2020, delaying cancer diagnosis and treatment. While early-stage thyroid cancer often progresses slowly, it is crucial to determine whether treatment delays associated with the pandemic have impacted the clinical presentation and management of advanced-stage thyroid cancer. The purpose of our study was to determine the impact of the early COVID-19 pandemic on thyroid cancer presentation and treatment times. Utilizing the National Cancer Database, chi-squared tests and regression analyses were performed to compare patient demographic and clinical characteristics over time for 56,011 patients diagnosed with primary thyroid cancer who were treated at the Commission on Cancer-accredited sites in 2019 and 2020. We found that thyroid cancer diagnoses decreased between 2019 and 2020, with the biggest drop among patients with cT1 disease relative to other T stages. We also found that patients diagnosed with thyroid cancer in 2020 had similar treatment times to patients diagnosed in 2019, as measured by both the time between diagnosis and start of treatment and the time between surgery and start of radioactive iodine therapy. Overall, our study suggests that resources during the pandemic were allocated to patients with advanced thyroid disease, despite a decrease in diagnoses.
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COVID-19 , Neoplasias de la Tiroides , Humanos , Neoplasias de la Tiroides/cirugía , Neoplasias de la Tiroides/epidemiología , COVID-19/epidemiología , Femenino , Masculino , Persona de Mediana Edad , Anciano , SARS-CoV-2 , Adulto , Pandemias , Tiempo de Tratamiento/estadística & datos numéricos , TiroidectomíaRESUMEN
Importance: Significant insurance status disparities have been demonstrated in head and neck cancer (HNC) outcomes. The effects of insurance status on HNC outcomes may be explained by differential access to high-quality care. Objective: To evaluate the association of insurance status with the quality of the treating hospital and receipt of guideline-compliant care among patients with HNC. Design, Setting, and Participants: This retrospective cohort study of data from the California Cancer Registry dataset linked with discharge records and hospital characteristics from the California Department of Health Care Access and Information included adult patients with HNC diagnosed between January 1, 2010, and December 31, 2019. Data were analyzed from May 10, 2023, to March 25, 2024. Exposures: Insurance status: commercial, Medicare, Medicaid, uninsured, other, or unknown. Main Outcomes and Measures: Quality of the treating hospital (tertiles), receipt of National Comprehensive Cancer Network guideline-compliant care, and overall survival. Results: A total of 23â¯933 patients (mean [SD] age, 64.8 [12.3] years; 75.3% male) met the inclusion criteria. Treatment in top-tertile hospitals (hazard ratio, 0.87; 95% CI, 0.79-0.95) was associated with improved overall survival compared with treatment in bottom-tertile hospitals. Medicare (odds ratio [OR], 0.78; 95% CI, 0.73-0.84), Medicaid (OR, 0.60; 95% CI, 0.54-0.66), and uninsured (OR, 0.38; 95% CI, 0.29-0.49) status were associated with lower likelihood of treatment in high-quality hospitals compared with commercial insurance. Among patients with advanced disease, Medicaid (OR, 0.72; 95% CI, 0.62-0.83) and uninsured (OR, 0.64; 95% CI, 0.44-0.93) patients were less likely to receive dual-modality therapy. Among patients with surgically resected advanced disease, Medicaid coverage (OR, 0.73; 95% CI, 0.58-0.93) was associated with lower likelihood of receiving adjuvant radiotherapy. Conclusions and Relevance: This study found significant insurance disparities in quality of care among patients with HNC. These findings highlight the need for continued health insurance reform in the US to improve the quality of insurance coverage, in addition to expanding access to health insurance.
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Neoplasias de Cabeza y Cuello , Disparidades en Atención de Salud , Cobertura del Seguro , Calidad de la Atención de Salud , Humanos , Femenino , Masculino , Neoplasias de Cabeza y Cuello/terapia , Neoplasias de Cabeza y Cuello/mortalidad , Persona de Mediana Edad , Estudios Retrospectivos , California , Cobertura del Seguro/estadística & datos numéricos , Estados Unidos , Anciano , Medicaid , Medicare , Sistema de Registros , Seguro de Salud/estadística & datos numéricos , Adhesión a Directriz/estadística & datos numéricosRESUMEN
OBJECTIVE: To determine whether immigrant status is associated with likelihood of audiogram and hearing aid use among US adults with hearing loss. STUDY DESIGN: Cross-sectional study. SETTING: Nationally representative data from 2009 to 2010, 2011 to 2012, 2015 to 2016, and 2017 to 2020 National Health and Nutrition Examination Survey (NHANES) cycles. METHODS: This cross-sectional study of 4 merged cycles of NHANES included 12,455 adults with subjective (self-reported) or objective (audiometric) hearing loss. Sequentially adjusted logistic regressions were used to assess the association of immigration status with likelihood of having undergone audiogram among those with objective and self-reported hearing loss, and with likelihood of hearing aid use among candidates with objective hearing loss. RESULTS: Immigrants were less likely to have received an audiogram among subjects with subjective (odds ratio [OR]: 0.81, 95% confidence interval [CI]: 0.75-0.87), and objective (OR: 0.76, 95% CI: 0.72-0.81) hearing loss, compared to nonimmigrants. The association persisted for those with subjective (OR: 0.88, 95% CI: 0.81-0.96), and objective (OR: 0.87, 95% CI: 0.80-0.96) hearing loss after adjusting for sociodemographic factors, comorbidities, insurance, and hearing quality, but disappeared in both groups after adjusting for English proficiency. Immigrants were less likely to use hearing aids (OR: 0.90, 95% CI: 0.87-0.93). However, this association disappeared (OR: 0.98, 95% CI: 0.93-1.04) in the adjusted model. CONCLUSION: Immigrant status is a significant barrier to hearing health care and is associated with lower rates of audiometric testing and hearing aid use among individuals with hearing loss.
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Thyroid cancer is the most common endocrine malignancy in the pediatric population. A recent study has revealed a recent decline in overall US thyroid cancer incidence rates. The aim of this study is to assess whether there has been a corresponding decline in incidence rates in the pediatric population. We used the Surveillance, Epidemiology, and End Results (SEER) database to analyze the pediatric thyroid cancer incidence rate. The results demonstrate that the incidence rate of pediatric thyroid cancer continued to increase from 2000 to 2018. Future studies are needed to understand how recent changes in guidelines are affecting incidence rates.
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Programa de VERF , Neoplasias de la Tiroides , Humanos , Neoplasias de la Tiroides/mortalidad , Neoplasias de la Tiroides/epidemiología , Estados Unidos/epidemiología , Niño , Incidencia , Masculino , Femenino , Adolescente , Preescolar , Lactante , Recién NacidoRESUMEN
OBJECTIVE: To compare thyroid cancer incidence rates and trends between Korean, non-Korean Asian, and non-Hispanic White populations in the United States, and between the US Korean population and the South Korean population. METHOD: Population-based analysis of cancer incidence data. Cases of thyroid cancer diagnosed during 1999-2014 from the Korean Central Cancer Registry (KCCR) and the Surveillance, Epidemiology, and End Results (SEER) 9 detailed Asian/Pacific Islander subgroup incidence and population dataset were included. Incidence rates were obtained from the datasets, and annual percent change (APC) of the incidence rates was calculated using Joinpoint regression analysis. RESULTS: Thyroid cancer incidence rate for 1999-2014 was significantly higher for South Korea (48.05 [95% CI 47.89-48.22] per 100,000 person-years) than for the US Korean population (11.12 [95% CI 10.49-11.78] per 100,000 person-years), which was slightly higher than the Non-Korean Asian population (10.23 [95% CI 10.02-10.43] per 100,000 person-years), and slightly lower than the Non-Hispanic White population (12.78 [95% CI 12.69-12.87] per 100,000 person-years). Incidence rates in South Korea increased dramatically (average APC 17.9, 95% CI 16.0-19.9), significantly higher than the US Korean population (average APC 5.0, 95% CI 3.1-6.8), which was similar to the non-Korean Asian (average APC 2.5, 95% CI 0.9-4.2) and the non-Hispanic White (average APC 5.1, 95% CI 4.7-5.6) populations. CONCLUSIONS: South Korea's high thyroid cancer incidence rates cannot be attributed to genetic factors, but are likely due to health care system factors. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:4156-4160, 2024.
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Programa de VERF , Neoplasias de la Tiroides , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Asiático/estadística & datos numéricos , Incidencia , Sistema de Registros , República de Corea/epidemiología , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/etnología , Estados Unidos/epidemiología , Población Blanca/estadística & datos numéricos , Pueblos del Este de Asia/estadística & datos numéricosRESUMEN
OBJECTIVE: To determine whether nonopioid analgesic regimens, taken after discharge for thyroid and parathyroid surgery have noninferior pain outcomes in comparison to opioid analgesic regimens. Secondarily, we sought to determine if nonopioid analgesic regimens decrease the number of opioid medications taken after thyroid and parathyroid surgery, and to assess adverse events associated with opioid versus nonopioid regimens. DATA SOURCES: PubMed, Embase, Cochrane. REVIEW METHODS: A comprehensive search of the literature was performed according to the PRISMA guidelines, and identified 1299 nonduplicate articles for initial review of which 2 randomized controlled trials (RCTs) were identified as meeting all eligibility criteria. Meta-analysis was not conducted due to heterogeneity in the data and statistical analyses. RESULTS: Both RCTs included in this systematic review found no significant differences in postoperative pain scores between individuals discharged with a nonopioid only analgesic regimen compared to analgesic regimen that included oral opioid medications. One study reported significantly increased number of postoperative calls related specifically to pain in the nonopioid arm compared to the opioid arm (15.6% vs. 3.2%, P = .045). CONCLUSION: This systematic review of RCTs revealed a limited number of studies examining nonopioid versus opioid postoperative pain medications among adults who undergo thyroid and parathyroid surgery. Among the 2 RCTs on this topic, there is a shared finding that nonopioid analgesic regimens are noninferior to opioid analgesic regimens in managing postoperative pain after thyroid and parathyroid surgery, supporting the use of nonopioid pain regimens given the risk of opioid dependence associated with prescription opioid medications.
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Analgésicos no Narcóticos , Analgésicos Opioides , Adulto , Humanos , Analgésicos Opioides/efectos adversos , Analgésicos no Narcóticos/uso terapéutico , Glándula Tiroides/cirugía , Analgésicos/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológicoRESUMEN
Oral squamous cell carcinoma (OSCC) in non-smoking and non-drinking (NSND) individuals appears to be distinct from the traditional head and neck squamous cell carcinoma (HNSCC). The incidence of this subset is increasing, as are the number of studies examining its characteristics. NSND OSCC individuals tend to be younger (<45 years) compared to traditional HNSCC patients. The proportion of females in the NSND OSCC cohort is also higher. The tongue is the predominantly affected subsite. Studies have revealed several gene mutations and unique epigenomic profiles but no definitive genetic etiology. Transcriptomic analysis has not found any causative viral agents. Other proposed etiologies include chronic dental trauma, microbiome abnormalities, marijuana consumption, and genetic disorders. There are international efforts to determine the relative prognostic outcome of this unique cohort, but no consensus has been reached. Here, we review the incidence, demographics, subsite, possible etiologies, prognosis, and therapy implications of the NSND OSCC cohort.
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Carcinoma de Células Escamosas , Neoplasias de Cabeza y Cuello , Neoplasias de la Boca , Femenino , Humanos , Neoplasias de la Boca/diagnóstico , Neoplasias de la Boca/epidemiología , Neoplasias de la Boca/etiología , Carcinoma de Células Escamosas de Cabeza y Cuello/epidemiología , Carcinoma de Células Escamosas de Cabeza y Cuello/etiología , Carcinoma de Células Escamosas de Cabeza y Cuello/terapiaRESUMEN
OBJECTIVE: Despite the high prevalence and morbidity of hearing loss, many individuals with hearing loss do not have access to hearing healthcare. This study aims to assess the relationship between insurance status and prior audiogram, and hearing aid use among subjects with hearing loss. MATERIALS AND METHODS: This cross-sectional study of the 2009-10, 2011-12, and 2015-16 cycles of the U.S. National Health and Nutrition Examination Survey (NHANES) included 5270 adult subjects 18 years or older with subjective or audiometric hearing loss. Subjects were stratified by insurance: Medicare, Medicaid, private, uninsured, and 'other or unspecified'. RESULTS: After adjusting for covariates, among subjects with audiometric hearing loss, prior audiogram was not associated with insurance type, including no insurance (OR 0.80, 95 % CI 0.45 to 1.42), Medicare (OR 1.34, 95 % CI 0.69 to 2.59), Medicaid (OR 1.27, 95 % CI 0.55 to 2.93), or 'other or unspecified' (OR 1.73, 95 % CI 0.67 to 4.47). Hearing aid use was not associated with insurance type, including no insurance (OR 0.20, 95 % CI 0.03 to 1.29), Medicare (OR 0.56, 95 % CI 0.27 to 1.14), Medicaid (OR 2.03, 95 % CI 0.47 to 8.71), or 'other or unspecified' (OR 1.76, 95 % CI 0.59 to 5.23). CONCLUSIONS: Health insurance status was not associated with hearing healthcare use in our nationally-representative sample of individuals with hearing loss. Given variations in hearing coverage by Medicaid between states, future studies should compare the impact of Medicaid insurance on hearing aid use between states that cover hearing aids and those that do not.
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Sordera , Pérdida Auditiva , Adulto , Humanos , Estados Unidos/epidemiología , Anciano , Medicare , Encuestas Nutricionales , Estudios Transversales , Cobertura del Seguro , Pérdida Auditiva/epidemiología , Pérdida Auditiva/terapia , Audición , Atención a la SaludRESUMEN
Importance: Human papillomavirus (HPV) is strongly associated with head and neck cancer, and HPV status is considered a prognostic factor. Being a sexually transmitted infection, HPV-related cancers may have greater risk of stigma and psychological distress; however, the potential association of HPV-positive status with psychosocial outcomes, such as suicide, is understudied in head and neck cancer. Objective: To investigate the association between HPV tumor status and suicide risk among patients with head and neck cancer. Design, Setting, and Participants: This population-based retrospective cohort study included adult patients with clinically confirmed cases of head and neck cancer based on HPV tumor status from the Surveillance, Epidemiology, and End Results database from January 1, 2000, to December 31, 2018. Data analysis was conducted from February 1 to July 22, 2022. Main Outcomes and Measures: The outcome of interest was death by suicide. Primary measure was HPV status of tumor site, dichotomized as positive or negative. Covariates included age, race, ethnicity, marital status, cancer stage at presentation, treatment modality, and type of residence. Cumulative risk of suicide among patients with HPV-positive and HPV-negative head and neck cancer was assessed using Fine and Gray competing risk models. Results: Of 60â¯361 participants, the mean (SD) age was 61.2 (13.65) years, and 17â¯036 (28.2%) were women; there were 347 (0.6%) American Indian, 4369 (7.2%) Asian, 5226 (8.7%) Black, 414 (0.7%) Native Hawaiian or Other Pacific Islander, and 49â¯187 (81.5%) White individuals. A competing risk analysis showed a significant difference in the cumulative incidence of suicide between HPV-positive cancers (5-year suicide-specific mortality, 0.43%; 95% CI, 0.33%-0.55%) and HPV-negative cancers (5-year suicide-specific mortality, 0.24%; 95% CI, 0.19%-0.29%). Tumor status that was HPV positive was associated with increased suicide risk in the unadjusted model (hazard ratio [HR], 1.76; 95% CI, 1.28-2.40), but not the fully adjusted model (adjusted HR, 1.18; 95% CI, 0.79-1.79). Among people with oropharyngeal cancer only, HPV status was associated with increased suicide risk, but the width of the confidence interval prevented definitive conclusion (adjusted HR, 1.61; 95% CI 0.88-2.94). Conclusions and Relevance: The results of this cohort study suggest that patients with HPV-positive head and neck cancer have similar risk of suicide as patients with HPV-negative cancer, despite differences in overall prognosis. Early mental health interventions may be associated with reduced suicide risk in all patients with head and neck cancer and should be assessed in future work.
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Neoplasias de Cabeza y Cuello , Neoplasias Orofaríngeas , Infecciones por Papillomavirus , Adulto , Humanos , Femenino , Persona de Mediana Edad , Masculino , Virus del Papiloma Humano , Estudios Retrospectivos , Estudios de Cohortes , Infecciones por Papillomavirus/epidemiología , Neoplasias de Cabeza y Cuello/terapia , Neoplasias de Cabeza y Cuello/complicaciones , Neoplasias Orofaríngeas/terapiaRESUMEN
OBJECTIVE: To offer pragmatic, evidence-informed guidance on the use of systemic corticosteroids (SCS) for common otolaryngologic disorders. DATA SOURCES: PubMed, Cochrane Library, and American Academy of Otolaryngology-Head and Neck Surgery Foundation clinical practice guidelines. REVIEW METHODS: A comprehensive search of published literature through November 2021 was conducted on the efficacy of SCS, alone or in combination with other treatments, for managing disorders in otolaryngology and the subdisciplines. Clinical practice guidelines, systematic reviews, and randomized controlled trials, when available, were preferentially retrieved. Interventions and outcomes of SCS use were compiled to generate summary tables and narrative synthesis of findings. CONCLUSIONS: Evidence on the effectiveness of SCS varies widely across otolaryngology disorders. High-level evidence supports SCS use for Bell's palsy, sinonasal polyposis, and lower airway disease. Conversely, evidence is weak or absent for upper respiratory tract infection, eustachian tube dysfunction, benign paroxysmal positional vertigo, adenotonsillar hypertrophy, or nonallergic rhinitis. Evidence is indeterminate for acute laryngitis, acute pharyngitis, acute sinusitis, angioedema, chronic rhinosinusitis without polyps, Ménière's disease, postviral olfactory loss, postoperative nerve paresis/paralysis, facial pain, and sudden sensorineural hearing loss. IMPLICATIONS FOR PRACTICE: Clinicians should bring an evidence-informed lens to SCS prescribing to best counsel patients regarding the risks, anticipated benefits, and limited data on long-term effects. Alternate routes of corticosteroid administration-such as sprays, drops, inhalers, and intralesional injections-may be preferable for many disorders, particularly those that are self-limited or require a prolonged duration of therapy. Prudent use of SCS reduces the risk of medication-related adverse effects. Clinicians who are conversant with high-level evidence can achieve optimal outcomes and stewardship when prescribing SCS.
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Parálisis de Bell , Otolaringología , Enfermedades Otorrinolaringológicas , Sinusitis , Humanos , Esteroides , Corticoesteroides/uso terapéutico , Enfermedades Otorrinolaringológicas/tratamiento farmacológico , Enfermedades Otorrinolaringológicas/cirugía , Parálisis de Bell/tratamiento farmacológico , Sinusitis/tratamiento farmacológico , Sinusitis/cirugíaRESUMEN
OBJECTIVE: To assess the incidence, clinical presentation, and survival in Native Hawaiian and other Pacific Islander (NHPI) patients with well-differentiated thyroid cancer. STUDY DESIGN: This population-based incidence analysis and retrospective cohort study utilized data from the Surveillance, Epidemiology, and End Results database. SETTING: Incidence analysis included patients diagnosed between 1990 and 2014, while the cohort to study clinical presentation and survival comprised patients diagnosed between 2004 and 2015. METHODS: Incidence rates and trends were compared among NHPI, Asian, and non-Hispanic White (NHW) populations. Clinical presentation was assessed via multivariable logistic regression. Survival was assessed per Cox regression. RESULTS: Recent incidence trends (2009-2014) show that the rate of increase remained consistent among NHPI patients (annual percentage change, 3.67%; 95% CI, 2.66%-4.69%), while it slowed in the NHW population and plateaued among Asians as compared with previous years. NHPI patients were more likely to present with distant metastasis than NHW patients (odds ratio, 3.37; 95% CI, 1.97-5.36) and Asian patients (odds ratio, 1.82; 95% CI, 1.05-2.97). NHPI race was also associated with advanced T stage and nodal metastasis as compared with the NHW race. Survival outcomes were similar among NHPI, NHW, and Asian patients. CONCLUSION: Well-differentiated thyroid cancer incidence has increased at a higher rate for the NHPI population as opposed to the NHW and Asian populations in recent years. NHPI patients are more likely to present with advanced disease when compared with NHW and Asian patients. These results highlight the importance of disaggregating the often-combined Asian/Pacific Islander group in epidemiologic studies.
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Nativos de Hawái y Otras Islas del Pacífico , Neoplasias de la Tiroides , Humanos , Incidencia , Nativos de Hawái y Otras Islas del Pacífico/estadística & datos numéricos , Pueblos Isleños del Pacífico/estadística & datos numéricos , Estudios Retrospectivos , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/mortalidad , Neoplasias de la Tiroides/patología , Programa de VERF/estadística & datos numéricos , Estados Unidos/epidemiología , Asiático/estadística & datos numéricos , Hispánicos o Latinos/estadística & datos numéricosAsunto(s)
Índice Ganglionar , Neoplasias de la Tiroides , Humanos , Cáncer Papilar Tiroideo/cirugía , Cáncer Papilar Tiroideo/patología , Neoplasias de la Tiroides/cirugía , Neoplasias de la Tiroides/patología , Disección del Cuello , Tiroidectomía , Ganglios Linfáticos/cirugía , Ganglios Linfáticos/patología , Recurrencia Local de Neoplasia/patología , Estudios RetrospectivosRESUMEN
Importance: Hearing loss is associated with higher hospitalization risk among older adults. However, evidence on whether hearing aid use is associated with fewer hospitalizations among individuals with hearing loss remains limited. Objective: To assess the association between audiometric hearing loss severity and hearing aid use and hospitalization. Design, Setting, and Participants: This population-based cross-sectional study used audiometric and health care utilization data for respondents aged 65 years or older from 4 cycles of the National Health and Nutrition Examination Survey from 2005 to 2016. Data were analyzed from February 23, 2021, to March 22, 2022. Exposures: Audiometric hearing loss severity and participant-reported hearing aid use. Main Outcomes and Measures: The main outcome was respondent-reported hospitalization in the past 12 months. Multivariable logistic regression was performed to assess the association of hearing loss severity with hospitalization. To assess the association of hearing aid use with hospitalization, propensity score matching was performed with 2:1 nearest neighbor matching without replacement. Results: Of 2060 respondents (mean [SD] age, 73.9 [5.9] years; 1045 [50.7%] male), 875 (42.5%) had normal hearing, 653 (31.7%) had mild hearing loss, 435 (21.1%) had moderate hearing loss, and 97 (4.7%) had severe to profound hearing loss. On multivariable analysis, moderate and severe hearing loss were associated with hospitalization (moderate hearing loss: odds ratio [OR], 1.50; 95% CI, 1.01-2.24; severe hearing loss: OR, 1.71; 95% CI, 1.03-2.84). Of 1185 respondents with at least mild hearing loss, 200 (16.9%) reported using a hearing aid. Propensity score-matched analysis showed that hearing aid use was not associated with hospitalization (OR, 1.17; 95% CI, 0.74-1.84), including among respondents with moderate or severe hearing loss (OR, 1.17; 95% CI, 0.71-1.92). Conclusions and Relevance: In this cross-sectional study, hearing loss was associated with higher risk of hospitalization, but hearing aid use was not associated with a reduction in hospitalization risk in the population with hearing loss. The association of hearing aid use with hospitalization should be evaluated in larger prospective studies with reliable data on the frequency of hearing aid use.
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Sordera , Audífonos , Pérdida Auditiva , Humanos , Masculino , Adulto , Persona de Mediana Edad , Anciano , Femenino , Estudios Transversales , Encuestas Nutricionales , Estudios Prospectivos , Pérdida Auditiva/diagnóstico , HospitalizaciónRESUMEN
Importance: Research studies often group Native Hawaiian and Other Pacific Islander individuals together with Asian individuals despite being consistently identified as having worse health outcomes and higher rates of comorbidities and mortality. Native Hawaiian and Other Pacific Islander individuals also have high incidence rates of oral cavity and pharyngeal cancer compared with the general population; however, disparities in clinical presentation and survival outcomes of head and neck cancer squamous cell carcinoma (HNSCC) among this population have not been investigated nor compared with those of other races. Objective: To determine the association of race with cancer stage at diagnosis and survival outcomes among Native Hawaiian and Other Pacific Islander patients with HNSCC compared with Asian and non-Hispanic White patients. Design, Setting, and Participants: This was a retrospective population-based cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) 18 database. Asian, Native Hawaiian or Other Pacific Islander, and non-Hispanic White adult patients diagnosed in 1988 through 2015 with HNSCC of the oral cavity, oropharynx, nasopharynx, larynx, and hypopharynx were included; any patient whose record was missing data on disease or demographic information was excluded. Main Outcomes and Measures: Cancer stage at presentation was compared among Asian, Native Hawaiian and Other Pacific Islander, and non-Hispanic White patients using a multivariable logistic regression model. Survival outcomes were compared among these racial groups using Cox regression models. Data analyses were performed from July 1, 2021, to March 20, 2022. Results: The total study population comprised 76 473 patients: 4894 Asian (mean [SD] age at presentation, 60.7 [14.6] years), 469 Native Hawaiian and Other Pacific Islander (57.8 [12.3] years), and 71 110 non-Hispanic White (62.2 [12.1] years) individuals. Native Hawaiian and Other Pacific Islander patients were more likely to present with advanced-stage HNSCC (odds ratio [OR], 1.38; 95% CI, 1.12 -1.72) compared with non-Hispanic White patients. Asian patients presented with similar stage disease (OR, 1.04; 95% CI, 0.97-1.11) compared with non-Hispanic White patients. Native Hawaiian and Other Pacific Islander patients had worse disease-specific survival (HR, 1.18; 95% CI, 1.02-1.36) compared with non-Hispanic White patients after adjusting for clinical and demographic factors. In contrast, Asian patients had improved disease-specific survival (HR, 0.93; 95% CI, 0.88-0.98) compared with non-Hispanic White patients. Conclusions and Relevance: This retrospective population-based cohort study suggests that Native Hawaiian and Other Pacific Islander race was associated with more advanced HNSCC, and worse disease-specific survival compared with non-Hispanic White race, while Asian race was associated with improved survival. This study highlights the importance of disaggregating Asian from Pacific Islander data when assessing health disparities, and the need for culturally sensitive interventions to promote earlier detection of head and neck cancer and improved survival among the Native Hawaiian and Other Pacific Islander population.
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Neoplasias de Cabeza y Cuello , Nativos de Hawái y Otras Islas del Pacífico , Adulto , Estudios de Cohortes , Detección Precoz del Cáncer , Neoplasias de Cabeza y Cuello/terapia , Humanos , Estudios Retrospectivos , Carcinoma de Células Escamosas de Cabeza y CuelloRESUMEN
The coronavirus pandemic has illuminated long-standing inequities in America's health care system and societal structure. While numerous studies have identified health care disparities within our specialty, few have progressed beyond detection. Otolaryngologists have the opportunity and the responsibility to act. Within this article, leaders from otolaryngology share their experience and perspective on health care disparities, including (1) a discussion of disparities in otolaryngology, (2) a summary of health care system design and incentives, (3) an overview of implicit bias, and (4) practical recommendations for providers to advance their awareness of health care disparities and the actions to mitigate them. While the path forward can be daunting, it should not be a deterrent. Throughout the course of this article, numerous resources are provided to support these efforts. To move ahead, our specialty needs to advance our level of understanding and develop, implement, and disseminate successful interventions toward the goal of eliminating health care disparities.
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Infecciones por Coronavirus , Otolaringología , Disparidades en Atención de Salud , Humanos , Otorrinolaringólogos , Pandemias/prevención & controlRESUMEN
Ectopic thyroid most commonly presents in the midline and is typically associated with the absence of an orthotopic thyroid. Less commonly, ectopic thyroid can present in the lateral neck, typically with a coexisting orthotopic thyroid and abnormal pathology in either the ectopic or orthotopic thyroid tissue. This paper describes a rare case of a benign, ectopic thyroid in the lateral neck (level II) associated with a normal, benign orthotopic thyroid. This report illustrates clinical pearls for the management of this unusual entity.
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OBJECTIVE: To provide a contemporary resource for clinicians and researchers on health equity research and implementation strategies to mitigate or eliminate disparities in health care. DATA SOURCES: Published studies and literature on health disparities, applicable research methodologies, and social determinants of health in otolaryngology. REVIEW METHODS: Literature through October 2021 was reviewed, including consensus statements, guidelines, and scientific publications related to health care equity research. This research focus provides insights into existing disparities, why they occur, and the outcomes of interventions designed to resolve them. Progress toward equity requires intentionality in implementing quality improvement initiatives, tracking data, and fostering culturally competent care. Priority areas include improving access, removing barriers to care, and ensuring appropriate and effective treatment. Although research into health care disparities has advanced significantly in recent years, persistent knowledge gaps remain. Applying the lens of equity to data science can promote evidence-based practices and optimal strategies to reduce health inequities. CONCLUSIONS: Health disparities research has a critical role in advancing equity in otolaryngology-head and neck surgery. The phases of disparities research include detection, understanding, and reduction of disparities. A multilevel approach is necessary for understanding disparities, and health equity extensions can improve the rigor of evidence-based data synthesis. Finally, applying an equity lens is essential when designing and evaluating health care interventions, to minimize bias. IMPLICATIONS FOR PRACTICE: Understanding the data and practices related to disparities research may help promote an evidence-based approach to care of individual patients and populations, with the potential to eventually surmount the negative effects of health care disparities.
Asunto(s)
Equidad en Salud , Otolaringología , Medicina Basada en la Evidencia , Investigación sobre Servicios de Salud , Disparidades en Atención de Salud , HumanosRESUMEN
Background: Thyroid cancer incidence has significantly increased in the United States over the past few decades. Recent studies have suggested a change in thyroid cancer incidence trends following 2013. The main objective of this study was to update the data on thyroid cancer incidence and mortality trends in the United States. Methods: Thyroid cancer incidence and incidence-based mortality trends were evaluated using the Surveillance, Epidemiology, and End Results-18 cancer registry. Cases of thyroid cancer diagnosed in 2000-2018 and thyroid cancer deaths during 2000-2018 were included. Annual percent change (APC) was calculated using joinpoint regression analysis. Results: Among 197,070 patients, female (75.6%) and white (81.0%) patients comprised the majority of cases. Papillary thyroid carcinoma (PTC) was the most common histology (89.1%). Incidence rates increased during 2000-2009 (APC 6.80, 95% confidence interval [CI 6.46 to 7.13]) and 2009-2014 (APC 2.58 [CI 1.71 to 3.47]) and then decreased during 2014-2018 (APC -2.33 [CI -3.15 to -1.51]). The incidence trends for PTC overall, localized disease, and tumors ≤1.0 cm mirrored the overall thyroid cancer trends, while incidence rates for regional disease stabilized during 2015-2018 (APC -1.65 [CI -4.09 to 0.84]). The incidence of distant disease decreased during 2015-2018 (APC -17.86 [CI -26.47 to -8.25]). The incidence of tumors ≤1.0 cm decreased (APC -5.83 [CI -7.24 to -4.40]), while the incidence of tumors 1.1-2.0 cm (APC -0.10 [CI -1.16 to 0.96]), 2.1-4.0 cm (APC 1.12 [CI -0.17 to 2.43]), and >4.0 cm (APC -1.13 [CI -4.58 to 2.45]) stabilized during the most recent 4-6 years. Incidence-based mortality increased throughout 2000-2018 (average APC 1.35 [CI 0.88 to 1.82]). Conclusions: Thyroid cancer incidence rates have declined since 2014. Similar declines are noted for PTC, localized disease, and tumors ≤1.0 cm, but not for tumors >2.0 cm. Incidence-based mortality rates continue to increase. These findings suggest that changing patterns in the management of thyroid nodules may have led to a decrease in diagnosis of small indolent tumors, but not more advanced tumors.