Disparities in SLP utilization for dysphagia (Mormer et al., 2024)

Purpose: Disparities in health care utilization are modifiable drivers of disparities in health outcomes but have not been explored regarding speech-language pathology utilization for patients with dysphagia. This study explores racial and ethnic disparities in the utilization of speech-language pathology services among adult patients diagnosed with oropharyngeal dysphagia during acute care hospitalizations.

Method: We analyzed New York State Inpatient Data on acute care hospitalizations in 2019. We identified adults with a diagnosis of oropharyngeal dysphagia and determined whether they received speech-language pathology services via revenue center codes, which indicate receipt of a speech-language pathology evaluation or treatment. Using generalized estimating equations, we estimated the effect of race/ethnicity (White, Black, Hispanic, and Other race) on speech-language pathology utilization (yes, no) during the acute care hospitalization, controlling for patient clinical characteristics (e.g., acute diagnoses and clinical comorbidities), demographic characteristics (e.g., insurance status, rural–urban status), and health system factors (e.g., hospital size). Subgroup analyses were conducted for select primary diagnoses (i.e., stroke, sepsis, and aspiration pneumonia).

Results: We identified 56,198 individuals with a diagnosis of oropharyngeal dysphagia; 60.7% received speech-language pathology services. In the full sample analysis, the adjusted odds of speech-language pathology utilization were lower in Black relative to White individuals (odds ratio [OR] = 0.87 [0.76, 0.98], p = .026). Racial and ethnic disparities were present in the subgroup analyses, most notably for sepsis, where speech-language pathology utilization was significantly lower for Black, Hispanic, and Other race individuals (ORs from 0.61 to 0.77) relative to White individuals.

Conclusions: We found evidence of racial and ethnic disparities in the utilization of speech-language pathology services for patients with oropharyngeal dysphagia in the acute care setting that varied by primary diagnosis. Further research is needed to replicate these findings and to begin to understand the reasons behind these disparities.

Supplemental Material S1. Population-averaged model for primary analysis of SLP utilization odds during acute care hospitalization, n = 56,198.

Supplemental Material S2. Population-averaged model for stroke subgroup analysis of SLP utilization odds during acute care hospitalization, n = 4,594.

Supplemental Material S3. Population-averaged model for sepsis subgroup analysis of SLP utilization odds during acute care hospitalization, n = 9,363.

Supplemental Material S4. Population-averaged model for aspiration pneumonia subgroup analysis of SLP utilization odds during acute care hospitalization, n = 3,042.