Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · 2025
Dysphagia Care in the United States: Examining the Impact of the Affordable Care Act on Access to Care.
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Zhao Robin, He Linh, Albert Sara W, Li Alexandra, Rameau Anaïs
Аннотация
OBJECTIVE: To report the odds of dysphagia treatment among adults with self-reported dysphagia before and after the implementation of the Affordable Care Act (ACA).
STUDY DESIGN: Cross-sectional analysis.
SETTING: National Health Interview Survey (NHIS).
METHODS: Multivariate logistic regression.
RESULTS: This study included 490 million individuals from the 2012 and 2022 NHIS in weighted responses. Among 235 million individuals in 2012, 9.4 million (4.0%) reported dysphagia (median age, 56.0 years; interquartile range [IQR], 40.0-68.0 years; 60% female). Among 255 million adults in 2022, 15 million (5.9%) reported dysphagia (median age, 58.0 years; IQR, 40.0-71.0 years; 57% female). After adjusting for sociodemographic factors, adults in 2022 were significantly more likely than those in 2012 to report dysphagia (adjusted odds ratio [aOR], 1.64; CI, 1.43-1.87). However, there was no significant difference in the odds of reporting dysphagia treatment between 2012 and 2022. Subgroup analyses by age, race and ethnicity, and insurance type also revealed no significant differences when comparing the 2012 and 2022 cohorts. When examining general access to care, adults reporting dysphagia in 2022 were significantly less likely to delay medical care due to the cost compared to adults reporting dysphagia in 2012 (aOR, 0.52; 95% CI, 0.43-0.62).
CONCLUSION: Although more adults reported dysphagia in 2022 than in 2012, our results show no significant improvement in access to dysphagia treatment. This suggests that, although the ACA reduced cost-related barriers, it has not adequately addressed access to dysphagia care.
LEVEL OF EVIDENCE: IV.
STUDY DESIGN: Cross-sectional analysis.
SETTING: National Health Interview Survey (NHIS).
METHODS: Multivariate logistic regression.
RESULTS: This study included 490 million individuals from the 2012 and 2022 NHIS in weighted responses. Among 235 million individuals in 2012, 9.4 million (4.0%) reported dysphagia (median age, 56.0 years; interquartile range [IQR], 40.0-68.0 years; 60% female). Among 255 million adults in 2022, 15 million (5.9%) reported dysphagia (median age, 58.0 years; IQR, 40.0-71.0 years; 57% female). After adjusting for sociodemographic factors, adults in 2022 were significantly more likely than those in 2012 to report dysphagia (adjusted odds ratio [aOR], 1.64; CI, 1.43-1.87). However, there was no significant difference in the odds of reporting dysphagia treatment between 2012 and 2022. Subgroup analyses by age, race and ethnicity, and insurance type also revealed no significant differences when comparing the 2012 and 2022 cohorts. When examining general access to care, adults reporting dysphagia in 2022 were significantly less likely to delay medical care due to the cost compared to adults reporting dysphagia in 2012 (aOR, 0.52; 95% CI, 0.43-0.62).
CONCLUSION: Although more adults reported dysphagia in 2022 than in 2012, our results show no significant improvement in access to dysphagia treatment. This suggests that, although the ACA reduced cost-related barriers, it has not adequately addressed access to dysphagia care.
LEVEL OF EVIDENCE: IV.