(0817) Impact of Social Determinants of Health on Timely Diagnosis and Intervention for Vocal Fold Lesions

Introduction: Sociodemographic factors may influence timing of diagnosis and intervention for dysphonic patients with vocal fold lesions (VFL). We evaluate and compare patients’ timing of presentation and timing of treatment with social determinants of health.

Methods: A retrospective study of dysphonic patients with VFL from May 2018-December 2022 was conducted. Patient-reported symptom onset, clinical diagnosis, and treatment was collected. Lesions included polyps, nodules, cysts, granulomas, scar, leukoplakia, and carcinoma. Sociodemographic factors included race, gender, insurance, distance to hospital, and language. The relationship between demographics and time to diagnosis (TTD) (n = 207) and time to intervention (TTI) (n = 166) was explored for TTD or TTI of less than two years.

Results: Of 343 (194F: 149M), 207 patients presented within two years of symptom onset, and 136 presented after two years of symptoms. There was a significant association between diagnosis and gender (p < 0.001) and race (White vs non-White, p < 0.001). Male patients were more likely to present with carcinoma (adjusted residual (AR) = 4.188), female patients were more likely to have polyps and nodules (AR = 5.632). White patients were significantly more likely to have carcinoma (AR = 4.033.).

The mean TTD for patients who did not use interpretation was significantly less than those who did use interpretation during (156[166] days vs 214[189] days, p = 0.031). For patients diagnosed with leukoplakia, the mean TTD for White patients was significantly less than for non-White patients (61 [52] vs 172 [224] days, p = 0.038; Welch’s t-test).

Conclusions: Dysphonic patients with VFL who require interpreter services presented later than English-speaking patients. Language may contribute to delayed presentation due to communication and comprehension barriers discouraging health seeking behaviors. Furthermore, White patients presented sooner for vocal fold leukoplakia diagnosis than non-White patients. Further research is needed to understand whether differences are due to individual, cultural, or systemic barriers.