Can voice disorders matter as much as life-threatening comorbidities to patients' general health?

Abstract

Objective: National initiatives and funding agencies may deprioritize voice disorders relative to conditions such as malignancy, pulmonary, or cardiac disease. It is unknown whether the impact of voice problems is outweighed by other potentially more serious disease states. Our objective was thus to quantify the extent to which voice contributes to general health status when adjusting for concurrent, more life-threatening comorbidities.

Methods: Adults (n = 430) presenting to a tertiary care academic center with a primary voice complaint completed the Voice Handicap Index-10 (VHI-10) and the Patient-Reported Outcomes Measurement Information System global health short-form instrument (PROMIS). Medical comorbidities were categorized via the Deyo modification of the Charlson Comorbidity Index. The influence of voice and comorbid conditions on general health scores was assessed through multivariate ordinal regression. The potential for effect modification was also evaluated.

Results: VHI-10 mean scores were 11.4 (95% confidence interval [CI], 10.5 to 12.4). PROMIS physical and mental health t scores were 49.0 (95% CI, 48.0 to 49.9) and 51.6 (95% CI, 50.6 to 52.5), respectively. Global and social item scores were 3.4 (95% CI, 3.3 to 3.5) and 3.7 (95% CI, 3.6 to 3.8), respectively. The most prevalent comorbid conditions were pulmonary disease, malignancy, and connective tissue disorders. In all analyses, voice handicap was a significant predictor of general health, even when adjusting for comorbid conditions (VHI-10 β = -1.349, P < 0.001 for physical health; β = -1.278, P < 0.001 for mental health; β = -1.691, P < 0.001 for social health; β = -0.956, P < 0.001 for the global overview item).

Conclusion: In the observed population, voice health has a significant, multi-dimensional impact on general health, which is not subsumed by the presence of comorbidities.

Level of evidence: 4 Laryngoscope, 130:2405-2411, 2020.

Keywords: Voice; comorbidities; general health; outcomes; resource allocation.