Socioeconomic Deprivation and Vocal Handicap in Adults With Voice Disorders

Abstract

Objective: This study examined the relationship between socioeconomic deprivation and quality of life as measured by the Voice Handicap Index (VHI) in adults with voice disorders.

Methods: A cross sectional design was utilized. One-thousand one-hundred and twenty adults with voice disorders were included in this study (mean age = 53.6, SD = 16.5; males = 429 females = 788). Patients were divided into the following diagnostic groups: muscle tension dysphonia (32%), benign vocal fold lesions (29.4%), laryngospasm (12.3%), vocal fold paralysis (11.1%), neurological voice disorders (6.2%), laryngeal cancer (5.9%), and presbyphonia (3%). VHI scores, Grade Roughness Breathiness Asthenia and Strain (GRBAS) ratings, age, sex, employment status, and smoking history were extracted from initial voice evaluations. Socioeconomic deprivation was measured using the Area Deprivation Index (ADI).

Results: Patients living in areas with the highest socioeconomic deprivation presented with greater total (p < 0.001), functional (p < 0.001), physical (p < 0.001), and emotional VHI scores (p < 0.001) when compared to those living in more affluent areas-even when controlling for dysphonia severity, age, sex, voice-related diagnosis, employment status, and smoking history. The association between VHI and ADI was strongest for total score and emotional subscore, as VHI total scores increased by 0.32 (95% CI = 0.26-1.26, p < 0.001) and VHI Emotional scores increased by 0.18 (95% CI = 0.16-0.21, p < 0.001) for every 1-point increase in ADI.

Conclusions: Patients living with socioeconomic deprivation experienced greater voice-related handicap from voice disorders than those from more affluent backgrounds. Future work is needed to better characterize the relationship between quality of life and socioeconomic deprivation in those with voice disorders.

Keywords: Voice Handicap Index; dysphonia; quality of life; socioeconomic status; voice disorders.