Socioeconomic Status, Voice Disorder Risk, and Voice-Related Handicap Across Childhood

Abstract

Importance: Both voice disorders and socioeconomic deprivation can limit quality of life in pediatric populations. However, the association between socioeconomic status (SES), voice disorder prevalence, and voice-related handicap in children and adolescents has not been well understood. Objective: To examine the association between SES and voice disorder prevalence across childhood, as well as the association between SES and voice-related handicap. Design, setting, and participants: In this cross-sectional study, a sample of adolescents (age 13 to 17 years) and caregivers acting as proxies for school-aged children (age 4 to 12 years) were recruited from across the US and surveyed regarding vocal health between March and June 2023. Voice disorder prevalence was compared across SES proxies collected from caregivers, including annual household income, parent educational level, race and ethnicity, and residence information. Adolescents completed the Voice Handicap Index (VHI) and caregiver proxies completed the Pediatric Voice Handicap Index (P-VHI) on behalf of their school-aged children. Voice-related handicap was compared across participants with and without voice disorders as well as across SES proxies. Main outcomes and measures: Adolescents were surveyed regarding voice status, voice-related handicap, and proxies of SES. Results: Of 1656 children and adolescents in this study (mean [SD] age, 10.1 [4.1] years; 845 [51%] children identified as male, 792 [47.8%] female, 11 [0.7%] nonbinary, 5 [0.3%] transgender female, and 3 [0.2%] transgender male), those from homes making less than $30 000 annually were 82% more likely to report a voice disorder than those from homes making more than $100 000 annually (odds ratio, 1.82; 95% CI, 1.24-2.67). Both VHI and P-VHI scores were significantly larger in participants with voice disorders (mean [SD] VHI, 26.1 [22.3], mean [SD] P-VHI, 16.6 [15]) compared with those with healthy voices (mean [SD] VHI, 9.9 [15.1], Cohen d = 0.94; 95% CI, 0.73-1.15; mean [SD] P-VHI, 5.1 [10.1]; Cohen d = 1.06). In adolescents with voice disorders, VHI scores were significantly larger (worse) for those from homes making less than $30 000 (mean [SD], 35.3 [10.4]) compared with adolescents from homes making more than this amount (mean [SD], 23.6 [17.8]; Cohen d = 0.55; 95% CI, 0.34-0.75). For children, P-VHI scores were larger for those living in households making under $60 000 a year (mean [SD], 17.8 [7.5]) compared with children from higher-income homes (mean [SD], 11.3 [5.7]; Cohen d = 1.1; 95% CI, 0.90-1.29). Conclusions and relevance: In this study, children and adolescents from lower-SES homes reported higher voice disorder prevalence and greater voice-related handicap than their peers from higher-income homes. Future research is needed to elucidate the mechanisms underlying these findings and to further clarify the association between SES, voice disorder risk, and voice-related handicap across childhood.