{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T04:38:57Z","timestamp":1792730337076,"version":"4.5.0"},"reference-count":28,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"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":["Laryngoscope Investig Oto"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Idiopathic subglottic stenosis (iSGS) is a recurrent fibroinflammatory narrowing of the subglottis, typically affecting White pre\u2010 and perimenopausal women. While its etiology remains uncertain, inflammatory signaling, reflux, hormonal influences, and mycobacterial factors have been proposed. This study evaluated geographic variability in survey\u2010ascertained iSGS prevalence, exploring potential environmental correlates associated with regional disease distribution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective ecological analysis of self\u2010reported demographic and clinical data from members of an international iSGS online support group was performed. Responses were analyzed by continent, country, and US state or Canadian province. Estimated prevalence per 1,000,000 White females was calculated using census data and examined in relation to environmental and access\u2010related factors, including temperature, humidity, and particulate matter.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 4450 survey respondents, 99.3% were female and 83.8% reported symptom onset after age 30. Survey\u2010ascertained prevalence was highest in Wyoming (18.1), Utah (17.4), Iowa (15.3), Colorado (13.9), and Minnesota (12.1), and lowest in New Hampshire (1.2), Montana (1.5), Alaska (2.3), and Indiana (2.3). In Canada, survey\u2010ascertained prevalence was highest in Alberta (85.4) and Saskatchewan (65.3), and lowest in Quebec (2.9). Higher prevalence regions were geographically clustered in areas sharing dry or semi\u2010arid climates, higher elevation, higher temperature and lower humidity. PM2.5 modified the association between elevation and survey\u2010ascertained prevalence but was not independently associated with prevalence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>iSGS demonstrated geographic clustering in North America associated with higher altitude, lower humidity and higher temperatures; however, these ecological findings should be considered hypothesis\u2010generating and warrant further investigation using patient\u2010level exposure and biologic data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>This study represents Level 4 evidence given its ecological, cross\u2010sectional design.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lio2.70607","type":"journal-article","created":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T04:18:37Z","timestamp":1792729117000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Geographic Clustering of Idiopathic Subglottic Stenosis in North America: An Ecological Cohort Study"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-4925-1042","authenticated-orcid":false,"given":"Ava S.","family":"Harb","sequence":"first","affiliation":[{"name":"University of Michigan Medical School, University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Carson","sequence":"additional","affiliation":[{"name":"University of Michigan Ross School of Business, University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beau","family":"Ahrens","sequence":"additional","affiliation":[{"name":"Dalhousie University  Halifax Nova Scotia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Anderson","sequence":"additional","affiliation":[{"name":"Independent Researcher, Founder of International \u201cLiving With Idiopathic Subglottic Stenosis\u201d Support Community  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatemah","family":"Ramazani","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery University of Calgary  Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robbi A.","family":"Kupfer","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery University of Michigan  Ann Arbor Michigan 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