Rural-Urban Health Initiative Published Studies

Published April 6, 2020

Urban MJ, Wojcik C, Eggerstedt M, Jagasia AJ. Rural-Urban Disparities in Otolaryngology: The State of Illinois. Laryngoscope. 2021 Jan;131(1):E70-E75. doi: 10.1002/lary.28652. Epub 2020 Apr 6. PMID: 32249932.

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Objectives/hypothesis

To highlight rural-urban disparities in otolaryngology, and to quantify the disparities in access to otolaryngology specialist care across Illinois. Several studies across disciplines have shown increased prevalence and severity of disease in rural communities, relative to their urban counterparts. There is very little published quantifying a disparity in rural access to otolaryngologists.

Study design

Population study.

Methods

Counties in Illinois were classified based on urbanization level on a scale from I (most urban) to VI (least urban) using the 2013 National Center for Health Statistics (NCHS) Urban-Rural Classification scheme. The six urbanization levels include four metropolitan (I-IV) and two nonmetropolitan levels (V and VI). The name and practice location of all registered otolaryngologists in Illinois were collected using the American Academy of Otolaryngology website (ENTnet.org). Population data were recorded from the most recent US Census (2010).

Results

Two hundred seventy-eight academy-registered otolaryngologists were identified in Illinois. One hundred fifty-one of these providers were located in a single county categorized as a level I by the NCHS scheme. There are over 18,000 square miles and 600,000 persons living in NCHS level VI counties in Illinois with zero registered otolaryngologists. Overall, metropolitan counties (I-IV) averaged 1.32 otolaryngologists per 100,000 population, whereas nonmetropolitan counties (V and VI) averaged 0.46 otolaryngologists per 100,000 (P < .01).

Conclusions

There is a paucity of academy-certified otolaryngologists with primary practice locations in rural counties of Illinois. There is a significant rural population and massive land area with limited spatial access to otolaryngologic specialist care.

Published February 16, 2021

Losenegger T, Urban MJ, Jagasia AJ. Challenges in the Delivery of Rural Otolaryngology Care During the COVID-19 Pandemic. Otolaryngol Head Neck Surg. 2021 Jul;165(1):5-6. doi: 10.1177/0194599821995146. Epub 2021 Feb 16. PMID: 33588629.

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Though initially spared from the brunt of the COVID-19 pandemic, rural areas in the United States have been ravaged by the disease. With a higher-risk population at baseline and an already strained health care system, rural hospitals face severe challenges in delivering care during the pandemic. In otolaryngology specifically, there has been difficulty in ensuring patient access to care while maintaining safe environments for patients and staff. Partnership between academic medical centers and critical access rural hospitals is urgently needed to help improve care for vulnerable rural populations.

Published January 11, 2022

Urban MJ, Shimomura A, Shah S, Losenegger T, Westrick J, Jagasia AA. Rural Otolaryngology Care Disparities: A Scoping Review. Otolaryngol Head Neck Surg. 2022 Jun;166(6):1219-1227. doi: 10.1177/01945998211068822. Epub 2022 Jan 11. PMID: 35015580.

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Objective

To broadly synthesize the literature regarding rural health disparities in otolaryngology, categorize findings, and identify research gaps to stimulate future work.

Study design

Scoping review.

Data sources

A comprehensive literature search was performed in the following databases: PubMed/MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Google Scholar, and CINAHL.

Review methods

The methods were developed in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Peer-reviewed, English-language, US-based studies examining a rural disparity in otolaryngology-related disease incidence, prevalence, diagnosis, treatment, or outcome were included. Descriptive studies, commentaries, reviews, and letters to the editor were excluded. Studies published prior to 1980 were excluded.

Results

The literature search resulted in 1536 unique abstracts and yielded 79 studies that met final criteria for inclusion. Seventy-five percent were published after 2010. The distribution of literature was as follows: otology (34.2%), head and neck cancer (20.3%), endocrine surgery (13.9%), rhinology and allergy (8.9%), trauma (5.1%), laryngology (3.8%), other pediatrics (2.5%), and adult sleep (1.3%). Studies on otolaryngology health care systems also accounted for 10.1%. The most common topics studied were practice patterns (41%) and epidemiology (27%), while the Southeast (47%) was the most common US region represented, and database study (42%) was the most common study design.

Conclusion

Overall, there was low-quality evidence with large gaps in the literature in all subspecialties, most notably facial plastic surgery, laryngology, adult sleep, and pediatrics. Importantly, there were few studies on intervention and zero studies on resident exposure to rural populations, which will be critical to making rural otolaryngology care more equitable in the future.

Published July 12, 2023

Patel EA, Poulson TA, Shah M, Jagasia AA. Evaluation of Wait Times for Otolaryngology Appointments in Illinois. OTO Open. 2023 Jul 12;7(3):e63. doi: 10.1002/oto2.63. PMID: 37448623; PMCID: PMC10336491.

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Objective

The objective of this study was to quantify the wait times that patients may encounter for common clinical diagnoses when seeking otolaryngology care, while determining whether a wait time disparity exists based on geographic location within Illinois.

Methods

In November 2022, a list of Illinois otolaryngologists was obtained from www.entnet.org. Using a uniform script, each of the 291 otolaryngologists were contacted. The caller posed as a new patient with either sudden sensorineural hearing loss, a neck mass, or chronic sinusitis. Each clinic was called 3 times and wait times were recorded. One hundred fifty-eight otolaryngologists were included in the analysis.

Results

The average statewide wait time for a new patient presenting with sudden unilateral hearing loss, a neck mass, and chronic sinusitis was 18.0, 22.6, and 25.5 days, respectively. There was no statistically significant difference between urban and rural wait times.

Discussion

Although wait time differences were noted, the lack of urban versus rural p value significance may be attributed to the small sample size (n = 11) of rural otolaryngologists in Illinois. However, the overall wait times in this study were longer compared to those reported in other studies, suggesting that the current number of otolaryngologists in Illinois is inadequate to meet the public need.

Implications for practice

We have demonstrated that the current demand for otolaryngology care is outstripping the existing supply in Illinois. This suggests that an emphasis should be placed on training more otolaryngologists, or increasing the use of physician extenders, while incentivizing otolaryngologists to practice in rural areas.

Published March 15, 2024

Wang AW, Patel EA, Patel N, Poulson TA, Jagasia AA. Otolaryngology Care Disparities in American Indian Populations. OTO Open. 2024 Mar 15;8(1):e124. doi: 10.1002/oto2.124. PMID: 38495073; PMCID: PMC10941493.

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Our objectives were to quantify geographical disparities in otolaryngology care access with respect to American Indian (AI) populations and to identify gaps in care. Although increased incidence and mortality rates of ear, nose, and throat (ENT) conditions in AI populations are well documented, few studies address factors contributing to these differential outcomes. We conducted a cross-sectional study of US states with AI areas that either met the population threshold for the American Community Survey annual estimate or annual supplemental estimate. A 2-tailed t test was used to compare the geographic distribution of ENT providers practicing within AI areas against non-AI areas, showing a statistically significant difference (P < .001) in the concentration of providers (0.409 vs 2.233 providers per 100,000 patients). To our knowledge, this is the first study to explore geographic barriers contributing to AI disparities within otolaryngology.

Published March 23, 2024

Pozin M, Nyaeme M, Peterman N, Jagasia A. Geospatial evaluation of access to otolaryngology care in the United States. Laryngoscope Investig Otolaryngol. 2024 Mar 23;9(2):e1239. doi: 10.1002/lio2.1239. PMID: 38525122; PMCID: PMC10960241.

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Objectives

This county-level epidemiological study evaluated the travel distance to the nearest otolaryngologist for continental US communities and identified socioeconomic differences between low- and high-access regions.

Methods

Geospatial analysis of publicly available 2015-2022 NPI records was combined with US census data to identify geospatial gaps in otolaryngologist distribution. Moran's index geospatial clustering in distance to the nearest county with an otolaryngologist was used as the core metric for differential access determination. Univariate logistic analysis was conducted between low- and high-access counties for 20 socioeconomic and demographic variables.

Results

Nationally, the average person was 22 miles from an otolaryngologist. 444 counties were identified as geospatially "low access" with increased travel distance in the Midwest, Great Planes, and Nevada with a median of 47 miles. 1231 counties in the Eastern United States and Western Coast were identified as "high access" with a 3-mile median travel distance. Areas of low access to otolaryngological care had smaller median populations (12,963 vs. 558,306), had smaller percent Black and Asian populations (2% vs. 11%, 1% vs. 5%, respectively), had a greater percent American Indian population (2% vs. 1%), were less densely populated (8 vs. 907 people per square mile), had fewer percent college graduates (20% vs. 34%), and fewer otolaryngologists per county (median: 0.01-20).

Conclusion

These findings highlight disparity in otolaryngology care in the United States and the need for otolaryngology funding initiatives in the Midwest and Great Plains regions.