Aetiological embedding of social determinants - How cause of disease mediates socioeconomic disparities in outcomes of laryngotracheal stenosis

Description

Aetiological embedding of social determinants. While SES was not directly associated with LTS outcomes, it was associated with cause of disease, a pattern we term the aetiological embedding of social determinants. Low SES was associated with trauma related stenosis (complex surgery needed but favorable decannulation prospects), and high SES with infectious causes (less severe, often managed endoscopically). These findings suggest that social forces may become inscribed in clinical outcomes by shaping disease pathogenesis, though causal interpretation requires caution given observational design and sparse data.

Steps to reproduce

This retrospective cohort study included 126 consecutive patients with LTS managed in South Africa's Eastern Cape Province between 2005–2024. SES was measured using an adaptation of the Social Capital Assessment Tool that included only items documented at or before first specialist presentation (i.e., baseline-constrained). This approach preserved temporal ordering by excluding post-presentation adherence or engagement items. Scores were categorized as Low/Moderate (0–5) versus High (6–7). Cause of disease was classified as iatrogenic, post-traumatic, infectious, or other. Outcomes included severe stenosis (Cotton Myer III/IV), open surgical reconstruction (versus endoscopic or conservative management), and treatment success (patent airway >6 months following decannulation). Exploratory mediation was assessed using generalized structural equation modelling and the Karlson Holm Breen method, adjusting for comorbidity burden.

Institutions

• Walter Sisulu University

  Eastern Cape, Mthatha

Categories

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