Barriers in Access to Care Among Individuals With Self-Reported Dysphagia in the US

Introduction: Research on barriers in access to care among individuals with dysphagia in the United States is limited. This study aims to investigate sociodemographic differences in the prevalence of cost and non-cost barriers to care among adults with self-reported dysphagia.

Methods: A cross-sectional study of survey data from the 2022 National Health Interview Survey (NHIS) was conducted. Multivariate logistic regression was used to examine the association of sociodemographic factors with barriers to care among adults with self-reported dysphagia, controlling for age, sex, race/ethnicity, region within the US, and socioeconomic status.

Results: This study included 27,651 adults, representing 255 million individuals in weighted responses; 1,719 were adults with self-reported dysphagia (median age, 58.0 years [IQR, 39.0-71.0 years]; 1017 [59.2%] female) and 25,932 were adults without self-reported dysphagia (median age, 54.0 years [IQR, 37.0-68.0 years]; 14033 [54.1%] female). We found sociodemographic factors such as older age, female sex, lower income, public insurance coverage, and unemployment to be independently associated with increased odds of reporting dysphagia. Compared with adults without dysphagia, adults with self-reported dysphagia were significantly more likely to delay medical care (adjusted odds ratio [aOR], 2.57; 95% CI, 2.19-3.01), mental health care (aOR, 2.30; 95% CI, 1.91-2.75), and prescription filling (aOR, 2.03; 95% CI, 1.68-2.45) due to cost. Additionally, adults who reported dysphagia were significantly more likely than those without dysphagia to delay care due to lack of transportation (aOR, 2.25; 95% CI, 1.91-2.63), a long commute to the doctor’s office (aOR, 2.06 95% CI, 1.60-2.62), unavailability during clinic hours (aOR, 1.86; 95% CI, 1.61-2.13), and lack of available appointment times (aOR, 2.41; 95% CI, 2.12-2.74).

Conclusions: Sociodemographic groups at higher risk for dysphagia may be disproportionately impacted by several barriers to care. Otolaryngologists and other health care practitioners have an important role in creating interventions to decrease these barriers to care.