Socioeconomic Disparities in Otolaryngology: No Easy Explanations, No Easy Answers

We found that the patients with AFRS came from counties that had a higher percentage of residents below the poverty line, lower median income, and a higher percentage of African-Americans, Dr. Schlosser said. About 24% of patients in the study were Medicaid patients or uninsured.

For his own specialty, Dr. Schlosser finds it worth knowing something about how SES may be affecting his patients. It does impact how I treat patients…because you know that they’re probably not going to get as much care when they leave you. And if they’re uninsured, they’re going to have more trouble accessing care or obtaining prescribed medications, he said. Still, there are a number of things not yet known about the pathophysiology and optimal treatment of AFRS, and learning more about patient populations and SES can lead to more answers.

Inequities in Canada

However, insurance status doesn’t explain everything. Looking north to Canada, where there is universal health coverage, there are still disparities evident between people from different socioeconomic groups, according to Keith Denny, PhD, Acting Manager of the Canadian Population Health Initiative (CPHI). He noted that research from Canada and the UK both show that lower-SES populations may have less access to specialty health services as well as primary health care, and are at higher risk of being hospitalized for conditions for which hospitalization may be preventable.

If you’re low income or if you have lower educational attainment, you are much more likely to have poorer health than those with higher income. We don’t know why. There aren’t a lot of studies that really dig away at the mechanisms that link income to health outcomes, or education to health outcomes, he said.

Causes for disparities in health and health care use are complex. It’s entirely plausible that there is no single explanation-that it’s a cluster of different reasons that might change during the course of a person’s life….Income and education might have different roles at different points in people’s lives, Dr. Denny said.

Even factors such as where one lives may have an impact. For instance, a study released by CPHI last year showed that people who live in walkable downtown environments are less likely to be overweight or obese than people who live in suburban neighborhoods, who are more reliant on driving than on walking to their destinations.

If we focus exclusively on health services, we miss a huge part of what it is that’s actually associated with the kinds of things that make people-and groups of people-healthy, he said. Addressing SES-related issues outside the health care system can affect overall health.