Objective: To determine the impact of social determinants of health on patient-perceived outcomes and patterns in access to rhinology care at a tertiary academic medical center.
Methods: Adult patients undergoing outpatient care of chronic rhinitis and chronic rhinosinusitis were recruited to enroll in this study. Enrolled patients were asked to participate in a telephone survey assessing symptoms, social/emotional consequences of disease, and barriers to care on a 5-point Likert scale. A social deprivation index (SDI; 0-6) was constructed from survey measures: employment, income, education, car/home ownership, ratio of people/rooms in the home. Ordered logistic regression was used to examine associations between the SDI and perceptions of barriers to rhinology care.
Results: 30 patients (46% response rate) participated in the survey. Respondents were majority female (60%, n=18), black (56%, n=17), not employed (56.7%, n=17), and had low income (lowest 2 tertiles, 86.6% n=26). There were significant numbers of single parents (27%, n=8), and car and home ownership were reported in 19 (66%) and 11 (37%). Having an SDI score of 2+ was associated with more difficulties obtaining saline (p=0.039) and trends towards increased difficulty using saline rinses properly (p=0.065) and using saline rinses as often as directed (p=0.090).
Conclusion: Worse social deprivation is associated with difficulties obtaining and using saline rinses in an urban, underserved, majority black population. These findings suggest social factors may affect access to and quality of rhinology care, and indicate the need for attention to social determinants of health in rhinology.