Population Health Insights: Comparing Comorbidities in Rural and Urban Otolaryngology and General Medicare Populations

Introduction: Patients’ comorbidities and location are strong predictors of health outcomes. To explore these factors, this study analyzed the difference between comorbidities of otolaryngology (ORL) patients compared to the general Medicare population and across rural and urban settings.

Methods: This cross-sectional study was conducted in January 2025. The 2021 Medicare Physician & Other Practitioners by Provider dataset was filtered by ORL and family practice (FP). FP was assumed to depict the general Medicare population. Only physicians with ≥100 patients were included. Multivariate Imputation by Chained Equations with Predictive Mean Matching over 5 iterations predicted missing values for comorbidity variables. The 2-tailed t-test compared ORL to FP nationally and by rurality (α=0.05). Means, 95% confidence intervals (CI), and p-values were calculated.

Results: In sum, 56,978 FPs and 7,116 ORLs were analyzed, and almost all variables differed significantly (p < 0.05). ORLs saw a higher proportion with asthma (ORL: 9.5 vs FP: 7.4% [CI: 2.0 to 2.2%]), cancer (11.9 vs 10.3% [1.5 to 1.6%]), hyperlipidemia (61.0 vs 56.4% [4.4 to 4.9%]), ischemic heart disease (34.2 vs 31.5% [2.5 to 2.9%]), osteoporosis (11.2 vs 9.6% [1.5 to 1.7%]), and rheumatoid/osteoarthritis (44.9 vs 39.6% [5.1 to 5.42%]). ORL also cared for a lower proportion with dementia (9.9 vs 13.5% [-3.7 to -3.4%]), heart failure (16.3 vs 18.6% [-2.4 to -2.1%]), kidney disease (29.6 vs 32.7% [-3.3 to -2.9%]), depression (22.8 vs 24.4% [-1.8 to -1.5%]), diabetes (28.1 vs 30.8% [-2.8 to -2.4%]), psychotic disorders (1.8 vs 3.9% [-2.1 to -2.0%]), and stroke (5.5 vs 6.0% [-0.6 to -0.5%]). Compared to rural ORLs, urban ORLs had higher average risk scores (1.25 vs 1.17 [0.07 to 0.11]) explained by higher proportions of comorbidities.

Conclusions: Relative to the general Medicare population, ORL patients had higher proportions of conditions like asthma, cancer, and arthritis, while lower proportions of cognitive, mental, or metabolic diseases. Also, urban ORLs treated patients with higher risk scores. These insights allow ORLs to anticipate and manage patient outcomes.