{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T17:48:13Z","timestamp":1786470493848,"version":"build-2736575974"},"reference-count":36,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T00:00:00Z","timestamp":1778025600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T00:00:00Z","timestamp":1778025600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2026,9]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objective<\/jats:title>\n The voice handicap index\u201010 (VHI\u201010) and reflux symptoms index (RSI) are validated, patient\u2010reported outcome measures (PROMs) commonly used in laryngology to assess the subjective impact of voice disorders and severity of symptoms associated with laryngopharyngeal reflux, respectively. This study aims to evaluate the relationship between neighborhood\u2010level socioeconomic disadvantage, as measured by the area deprivation index (ADI), and patient\u2010reported laryngeal outcomes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n An analysis of 1310 adult patients who were referred to a tertiary care laryngology clinic between January and December 2024 was conducted. Patient addresses were geocoded and matched to corresponding ADI national percentile scores, and internally derived ADI quartiles were formed. Median VHI\u201010 and RSI scores by ADI quartile were compared using the Kruskal\u2010Wallis test. Multivariable linear regression was performed to investigate the association between ADI and VHI\u201010 or RSI scores, adjusting for sociodemographic (race, sex, and age) and clinical (comorbidities, depression\/anxiety, insurance status, BMI, and primary diagnosis) factors.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Patients living in the least deprived\n ADI<\/jats:styled-content>\n quartile had significantly lower median\n VHI<\/jats:styled-content>\n \u201010 and\n RSI<\/jats:styled-content>\n Scores, compared to patients in the most deprived\n ADI<\/jats:styled-content>\n quartile (10 vs. 14, and 15 vs. 20, respectively). In adjusted analysis, living in a higher\n ADI<\/jats:styled-content>\n area was significantly associated with a higher\n VHI<\/jats:styled-content>\n \u201010 (\n \u03b2<\/jats:italic>\n \u2009=\u20090.04, 95% confidence interval [\n CI<\/jats:styled-content>\n ]: 0.008\u20130.06) or\n RSI<\/jats:styled-content>\n (\n \u03b2<\/jats:italic>\n \u2009=\u20090.04, 95%\n CI<\/jats:styled-content>\n : 0.01\u20130.07) score.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Higher neighborhood socioeconomic deprivation is significantly associated with higher VHI\u201010 and RSI scores. Patients living in more deprived areas may face barriers to accessing care, including low health literacy and limited resources.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n 3.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/lary.70610","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T03:55:51Z","timestamp":1778126151000},"page":"3826-3840","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Neighborhood Deprivation and Voice and Reflux Symptom Burden in a Tertiary Laryngology Cohort"],"prefix":"10.1002","volume":"136","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3763-4259","authenticated-orcid":false,"given":"Sandra","family":"Stinnett","sequence":"first","affiliation":[{"name":"University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA"},{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirley X.","family":"Liu","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie M.","family":"Carlson","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA"},{"name":"Cancer Epidemiology and Prevention Program UPMC Hillman Cancer Center Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5840-0160","authenticated-orcid":false,"given":"Leah","family":"Helou","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Communication Science Disorders Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Libby","family":"Smith","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA"},{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chloe Santa","family":"Maria","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA"},{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela L.","family":"Mazul","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA"},{"name":"Cancer Epidemiology and Prevention Program UPMC Hillman Cancer Center Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,6]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlg.0000179174.32345.41"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.22426"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24740"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.31409"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2008.05.006"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005537\u2010200409000\u201000009"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0892\u20101997(02)00097\u20108"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/00333549141291S206"},{"key":"e_1_2_9_10_1","unstructured":"WHO \u201cSocial Determinants of Health \u201d accessed August 26 2025 https:\/\/www.who.int\/health\u2010topics\/social\u2010determinants\u2010of\u2010health."},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749\u20106632.2009.05333.x"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/AS9.0000000000000237"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/ohn.953"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/AUD.0000000000001188"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599817745269"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph111212866"},{"key":"e_1_2_9_17_1","doi-asserted-by":"crossref","unstructured":"B. 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