(0934) Exploring the Associations Between Social Determinants of Health and Outcomes of Cholesteatoma Care

Introduction: Limited data exist on the relationship between social determinants of health (SDOH) and cholesteatoma care, and many factors, like social connectedness and financial instability, have not been studied at all. Therefore, we sought to explore the relationship between stress, housing instability, financial resource strain, social connectedness, food insecurity, and intimate partner violence and the access to, delivery of, and outcomes of cholesteatoma care.

Methods: A retrospective chart review was performed for 237 adult patients with cholesteatoma who underwent surgery at any Mayo Clinic location between 2021 and 2023. Data were collected through REDCap software, including patients' demographics, SDOH risk factors at the time of diagnosis and the last visit, pre and postoperative audiometry, disease severity, surgical approach, and complication rates. Of the patients, 75 had a complete set of SDOH questionnaires at the time of diagnosis and descriptive and comparative statistics was performed using R software.

Results: Stress was the most prevalent SDOH risk factor, noted in 45 (60%) patients. Female patients (n = 23; 79.3%) were more likely to have one or more SDOH risk factors than males (n = 26; 56.5%; p = 0.05; [d = -0.24]). Patients with one or more SDOH risk factors were younger than those without any SDOH risk factors (mean age, range [45, 18-76 versus 61, 30-83 years]; p = 0.01; [d = -0.69]). These patients were also more likely to have an education level of high school or less (n = 23 [82.1%] vs n = 5 [17.9%]; p = 0.04; [d = -0.26]). No differences were found in any measure of access to, delivery of, and outcomes of care between patients with and without SDOH risk factors.

Conclusions: Stress is a prevalent SDOH risk factor among patients with cholesteatoma; however, it might not influence the access to and outcomes of cholesteatoma care. Though female sex, younger age, and lower education levels were associated with having at least one SDOH risk factor, these also do not appear to influence cholesteatoma care. Intentional studies on more extensive and heterogeneous populations are needed to confirm these observations.