ABSTRACT
Objective
Around 89% of individuals with Parkinson's disease (PD) present with speech and voice disorders, but only 3%–4% receive speech treatment. Using the NIH All of Us Research Program, this study aims to report the prevalence of dysphonia, the incidence of speech evaluations and treatments, and potential disparities in PD patients on a national scale.
Methods
ICD‐9 and ICD‐10 codes were used to identify individuals with PD and dysphonia in the All of Us database. Diagnostic voice care was determined using CPT codes for flexible laryngoscopy and speech evaluation, while treatment was based on CPT codes for vocal fold augmentation and speech therapy. Unadjusted and adjusted logistic regression analyses were conducted to evaluate the association between voice care access and demographic and socioeconomic factors.
Results
Of 1968 PD patients, 257 (13.1%) had a concomitant diagnosis of dysphonia. 1683 patients (85.5%) received no voice care. Among those with voice care, 264 (13.4%) underwent a diagnostic evaluation and 124 (6.3%) received treatment. Based on adjusted logistic regression models, factors associated with decreased odds of voice care were female sex (aOR = 0.62, 95% CI = 0.45–0.85, p = 0.004) and Hispanic ethnicity (aOR = 0.44, 95% CI = 0.22–0.90, p = 0.02).
Conclusion
PD commonly presents with voice disorders. Using a national database, only 13.1% of PD patients had a formal dysphonia diagnosis, and only 6.3% received speech treatment. Female sex and Hispanic ethnicity correlated with decreased voice care. This study suggests the underdiagnosis and undertreatment of dysphonia in PD.
Level of Evidence: 3.
Keywords: dysphonia, hypokinetic dysarthria, Parkinson's disease, speech disorders, voice therapy
Parkinson's disease (PD) commonly presents with speech and voice disorders. Using a national database, only 13.1% of individuals with PD had a formal dysphonia diagnosis, and only 6.3% received speech treatment. Female sex and Hispanic ethnicity correlated with decreased voice care among individuals with PD.
1. Introduction
Parkinson's disease (PD) is the second most common neurodegenerative condition, and its prevalence is projected to double as the population ages [1]. Approximately 89% of PD patients present with speech disorders, often as the first clinical manifestation of motor dysfunction [2, 3]. Speech and voice deficits worsen as PD progresses and may even serve as a marker for early diagnosis or monitoring disease severity [4, 5, 6, 7]. Communication challenges in PD significantly reduce quality of life, increasing the risk of social isolation, cognitive decline, caregiver burden, and poor healthcare access [8, 9].
Although standard PD treatments, such as dopaminergic medications and deep brain stimulation (DBS), reliably improve cardinal motor symptoms and resting tremor, the benefits on speech and voice are less clear [10, 11]. Recent studies reported that DBS had highly variable effects on speech, even exacerbating certain deficits such as phonation and articulation [12, 13, 14]. Targeted treatments that more effectively alleviate speech symptoms include vocal fold augmentation [11, 15] and behavioral speech and language therapy (SLT) [16, 17, 18, 19]. In a clinical trial of PD patients, vocal fold augmentation, which involves the use of injectable fillers to facilitate vocal fold closure, demonstrated significant improvement, but the effects were temporary, lasting around 8 weeks [15]. SLT, on the other hand, has been shown to benefit various aspects of speech and is regarded as more effective than pharmacological or surgical treatments in numerous reviews [11, 16, 18]. In particular, a form of SLT known as Lee Silverman Voice Treatment has shown promise in increasing voice volume and functional communication in individuals with PD, although additional research is required to validate this approach [20, 21]. Notably, despite the high incidence of speech disorders in PD and the lack of response to standard PD treatments including dopaminergic medications and DBS, only 3%–4% of patients receive speech treatment [3].
Existing literature on speech manifestations of PD largely centers around hypokinetic dysarthria, defined as a motor speech disorder that affects articulation, phonation, prosody, fluency, resonance, and respiration [22, 23]. Prominent features of hypokinetic dysarthria are a monotonous speech pattern, reduced loudness, decreased stress, and hoarse quality among others [22]. Dysphonia, on the other hand, refers to an alteration of voice quality or effort, leading to vocal tremor, hoarseness, strain, raspiness, altered pitch, breathiness, or vocal fatigue [24]. Anatomic laryngeal abnormalities, including incomplete glottic closure and hypoadduction or pronounced bowing of the vocal folds, underlie dysphonia in PD [25]. Because speech dysfunction in PD arises due to an interplay of motor and non‐motor deficits, dysarthria and dysphonia are closely interlinked and often overlapping etiologies. Since dysarthria also affects broader aspects of speech such as articulation and respiration, dysphonia was the primary focus for the purposes of this study. While many studies have characterized voice impairments in PD [13, 26, 27, 28], the extent of utilization of speech services on a national scale remains unclear. Thus, using a large national database, this study assesses the prevalence of dysphonia, rates of speech evaluations and laryngology procedures, and potential healthcare disparities in PD patients.
2. Materials and Methods
2.1. Study Population
The All of Us Research Program is a National Institutes of Health (NIH) initiative to develop a large, representative database of individuals in the US Adults aged 18 years or older with the capacity to consent and who willingly participated are included in the database, granting registered researchers access to de‐identified demographic, socioeconomic, electronic health record, and survey information. Version 7 of the data repository, released in April 2023 and including data collected through July 1, 2022, was utilized. This study was considered exempt by the Institutional Review Board (IRB) at the University of Arizona.
Diagnoses were determined using ICD‐9 and ICD‐10 codes. The study population included All of Us participants who had a diagnosis of PD, referred to as the PD group. Participants that had dysphonia without a diagnosis of PD, secondary Parkinsonism, or other neurological causes were also included as a comparison group. Neurogenic etiologies were excluded on the basis that such conditions often present with cognitive, communication, or mobility impairments, which could further complicate access to voice care [29]. Secondary Parkinsonism is a diagnostic entity that refers to symptoms of PD due to other insults, including medications, vascular lesions, traumatic encephalopathy, infectious or immunological diseases, and toxins [30]. Other neurological causes were defined as the following: Alzheimer's disease, Huntington's disease, dementia, progressive supranuclear palsy, spinocerebellar ataxia, amyotrophic lateral sclerosis (ALS), traumatic brain injury, or cerebrovascular accident (CVA). While this list of diagnoses may not be exhaustive, it encompasses most of the conditions that affect speech production. For the purposes of our study, we refer to this group that had dysphonia without an identifiable neurological etiology as non‐neurogenic dysphonia. All ICD‐9 and ICD‐10 codes are documented in Table S1.
2.2. Variables of Interest
Demographic and socioeconomic variables included in this study were age, sex at birth, race and ethnicity, highest education level, and annual household income. All data was collected from “The Basics” survey. Race and ethnicity categories were coded as Non‐Hispanic White, Black or African American, Asian, Hispanic, and Other. Education level was categorized as no college, some college, and college or advanced degree. Annual household income was grouped into ranges of under $50,000, between $50,000 to $100,000, and over $100,000.
The primary outcome was the incidence of receiving voice care among participants diagnosed with PD. Diagnostic voice care was defined as having at least one CPT code for diagnostic flexible laryngoscopy or speech‐language pathology evaluation. The types of speech‐language pathology evaluations considered were laryngeal function studies, behavioral and qualitative analyses of voice and resonance, as well as evaluations of speech fluency and sound production. Treatment was defined as having at least one CPT code for vocal fold augmentation or SLT. All CPT codes are documented in Table S2. Speech care and voice care are used interchangeably in this study as speech and voice production in PD are highly interconnected. Hence, SLT in the context of PD simultaneously treats both dysarthria and dysphonia.
2.3. Statistical Analysis
Descriptive statistics for demographic and socioeconomic characteristics of the study population were calculated. Percent frequencies were used to describe categorical variables, while mean and standard deviation were used to describe age. Chi‐square (χ 2) tests for all categorical variables and a t‐test for age were performed to compare characteristics of the PD versus non‐neurogenic dysphonia groups. Characteristics of PD patients with versus without voice care were similarly compared.
To assess the association between access to voice care and demographic and socioeconomic variables, unadjusted and adjusted logistic regression analyses were conducted. Adjusted models controlled for age, sex at birth, race and ethnicity, highest level of education, and annual household income. The unadjusted odds ratios (OR), adjusted odds ratios (aOR), 95% confidence intervals (CI), and p‐values were reported. P‐values were considered statistically significant at 0.05. All analyses were performed using R software version 4.1.0 in the NIH All of Us Researcher Workbench.
3. Results
Of the 409,420 participants in the AoU database, 1968 (0.5%) had a diagnosis of PD and were included in the PD cohort. 257 (13.1%) of these individuals had a concomitant diagnosis of dysphonia. Outside of the PD cohort, 6677 individuals had a diagnosis of dysphonia without an accompanying neurological condition and were included in the non‐neurogenic dysphonia group for comparison. Figure 1 illustrates a flowchart of the cohort.
FIGURE 1.
Flowchart illustrating diagnoses and rates of voice care in total cohort.
Demographic and socioeconomic characteristics of the study population are outlined in Table 1. In the PD cohort, the mean age was 66.8 ± 11.2. Of the 1913 individuals who disclosed sex at birth, 1122 (58.7%) were male and 791 (41.3%) were female. Of the 1885 individuals who disclosed race and ethnicity, 1471 (78.0%) identified as Non‐Hispanic White, 122 (6.5%) identified as Black or African American, 214 (11.4%) identified as Hispanic, 25 (1.3%) identified as Asian, and 53 (2.8%) identified as Other. Of the 1905 individuals who disclosed highest education level, 373 (19.6%) did not attend college, 476 (25.0%) attended some college, and 1056 (55.4%) completed a college or advanced degree. Of the 1517 individuals who disclosed annual household income, 643 (42.4%) earned under $50,000, 413 (27.2%) earned $50,000 to $100,000, and 461 (30.4%) earned over $100,000. Based on chi‐square and t‐test analyses, the PD group had a higher mean age (p < 0.001), a greater proportion of males (χ 2 = 526.0, p < 0.001), a greater proportion of Non‐Hispanic White individuals (χ 2 = 146.0, p < 0.001), and increased overall education levels (χ 2 = 13.9, p < 0.001) compared to the non‐neurogenic dysphonia group.
TABLE 1.
Characteristics of total cohort.
| Characteristics | Total (%) | Parkinson's disease (%) | Non‐neurogenic dysphonia (%) | p |
|---|---|---|---|---|
| Total participants | 8645 | 1968 c | 6677 | — |
| Mean age at diagnosis (SD) | 60.4 (14.2) | 66.8 (11.2) | 58.5 (14.4) | < 0.001*** |
| Sex at birth | 8455 a | 1913 a | 6542 a | < 0.001*** |
| Male | 3080 (36.4) | 1122 (58.7) | 1958 (29.9) | — |
| Female | 5375 (63.6) | 791 (41.3) | 4584 (70.1) | — |
| Race and ethnicity | 8368 a | 1885 a | 6483 a | < 0.001*** |
| Non‐Hispanic White | 5703 (68.2) | 1471 (78.0) | 4232 (65.3) | — |
| Black or African American | 1200 (14.3) | 122 (6.5) | 1078 (16.6) | — |
| Hispanic | 1067 (12.8) | 214 (11.4) | 853 (13.2) | — |
| Asian | 141 (1.7) | 25 (1.3) | 116 (1.8) | — |
| Other | 257 (3.1) | 53 (2.8) | 204 (3.1) | — |
| Education level | 8382 a | 1905 a | 6477 a | < 0.001*** |
| No college | 1783 (21.3) | 373 (19.6) | 1410 (21.8) | — |
| Some college | 2267 (27.0) | 476 (25.0) | 1791 (27.7) | — |
| College or advanced degree | 4332 (51.7) | 1056 (55.4) | 3276 (50.6) | — |
| Annual household income | 6874 a | 1517 a | 5357 a | 0.44 |
| Under $50,000 | 3012 (43.8) | 643 (42.4) | 2369 (44.2) | — |
| $50,000 to $100,000 | 1818 (26.4) | 413 (27.2) | 1405 (26.2) | — |
| Over $100,000 | 2044 (29.7) | 461 (30.4) | 1583 (29.6) | — |
| Voice care | 8645 | 1968 | 6677 | — |
| Received any voice care | 3145 (36.4) b | 285 (14.5) b | 2860 (42.8) b | < 0.001*** |
| Diagnostic evaluation | 3031 (35.1) | 264 (13.4) | 2767 (41.4) | < 0.001*** |
| Treatment | 1078 (12.5) | 124 (6.3) | 954 (14.3) | < 0.001*** |
| Received no voice care | 5500 (63.6) | 1683 (85.5) | 3817 (57.2) | — |
Participant counts are less than the total due to some participants skipping questions.
Participant counts for voice care types exceed total due to some participants receiving both diagnostic evaluation and treatment.
257 of 1968 (13.1%) participants with PD had a concomitant diagnosis of dysphonia.
The PD group had a significantly lower rate of voice care than the non‐neurogenic dysphonia group, with 285 of 1968 (14.5%) PD patients receiving any voice care compared to 2,860 of 6,677 (42.8%) non‐neurogenic dysphonia patients (χ 2 = 526.7, p < 0.001). Considering diagnostic evaluations and treatment separately, this trend holds true. 264 of 1968 (13.4%) PD patients underwent at least one diagnostic evaluation, defined as flexible laryngoscopy or speech evaluation, compared to 2,767 of 6,677 (41.4%) non‐neurogenic dysphonia patients (χ 2 = 523.1, p < 0.001). Similarly, 124 of 1968 (6.3%) PD patients received speech treatment, in the form of vocal fold augmentation or SLT, compared to 954 of 6677 (14.3%) non‐neurogenic dysphonia patients (χ 2 = 88.1, p < 0.001). 1683 of 1968 (85.5%) individuals in the PD cohort did not receive any voice care, compared to 3,817 of 6,677 (57.2%) individuals in the non‐neurogenic dysphonia cohort.
To identify potential disparities in voice care among PD patients, demographic and socioeconomic characteristics of PD patients who received voice care versus those who did not were evaluated (Table 2). Compared to those with voice care, the group of PD patients with no voice care had a higher proportion of females (χ 2 = 8.3, p = 0.004) and a lower proportion of individuals identifying as Non‐Hispanic White (χ 2 = 15.4, p = 0.004) based on chi‐square tests. Those with no voice care also had lower incomes overall, with a greater proportion of individuals reporting annual household incomes below $50,000 (χ 2 = 6.3, p = 0.04). Logistic regression analyses supported the findings pertaining to sex and race, but not income. In the PD cohort, female sex was associated with decreased odds of voice care based on unadjusted (OR = 0.67, 95% CI = 0.51–0.88, p = 0.003) and adjusted (aOR = 0.62, 95% CI = 0.45–0.85, p = 0.004) models (Table 3). Hispanic ethnicity also correlated with decreased odds of voice care based on unadjusted (OR = 0.47, 95% CI = 0.28–0.78, p = 0.004) and adjusted (aOR = 0.44, 95% CI = 0.22–0.90, p = 0.02) models (Table 3). Identifying as the Other race category predicted decreased voice care using unadjusted analyses (OR = 0.21, 95% CI = 0.05–0.88, p = 0.03), although this was no longer significant after adjusting for other covariates. No significant associations were found between rates of voice care in PD patients and education level nor income. Figure 2 summarizes the results of all adjusted logistic regression analyses.
TABLE 2.
Demographic and socioeconomic comparison of individuals with Parkinson's disease who received voice care versus no voice care.
| Characteristics | Total with Parkinson's disease (%) | Voice care (%) | No voice care (%) | p |
|---|---|---|---|---|
| Total participants | 1968 | 285 | 1683 | — |
| Mean age at diagnosis (SD) | 66.8 (11.2) | 67.8 (10.9) | 66.6 (11.3) | 0.09 |
| Sex at birth | 1913 a | 279 a | 1634 a | 0.004** |
| Male | 1122 (58.7) | 186 (66.7) | 936 (57.3) | — |
| Female | 791 (41.3) | 93 (33.3) | 698 (42.7) | — |
| Race and ethnicity | 1885 a | 271 a | 1614 a | 0.004** |
| Non‐Hispanic White | 1471 (78.0) | 229 (84.5) | 1242 (77.0) | — |
| Black or African American | 122 (6.5) | 21 (7.7) | 101 (6.3) | — |
| Hispanic | 214 (11.4) | b | b | — |
| Asian | 25 (1.3) | b | b | — |
| Other | 53 (2.8) | b | b | — |
| Education level | 1905 a | 275 a | 1630 a | 0.13 |
| No college | 373 (19.6) | 44 (16.0) | 329 (20.2) | — |
| Some college | 476 (25.0) | 64 (23.3) | 412 (25.3) | — |
| College or advanced degree | 1056 (55.4) | 167 (60.7) | 889 (54.5) | — |
| Annual household income | 1517 a | 225 a | 1292 a | 0.04* |
| Under $50,000 | 643 (42.4) | 79 (35.1) | 564 (43.7) | — |
| $50,000 to $100,000 | 413 (27.2) | 73 (32.4) | 340 (26.3) | — |
| Over $100,000 | 461 (30.4) | 73 (32.4) | 388 (30.0) | — |
Participant counts are less than the total due to some participants skipping questions.
Following All of Us guidelines, participant counts less than 20 cannot be reported.
TABLE 3.
Unadjusted and adjusted logistic regression models evaluating the associations between demographic and socioeconomic factors and odds of receiving any voice care in the Parkinson's disease cohort.
| Predictor variables | Unadjusted model | Adjusted model | ||||
|---|---|---|---|---|---|---|
| OR | 95% CI | p | OR | 95% CI | p | |
| Age | 1.01 | (1.00, 1.02) | 0.09 | 1.01 | (0.99, 1.02) | 0.32 |
| Female (ref = male) | 0.67 | (0.51, 0.88) | 0.003** | 0.62 | (0.45, 0.85) | 0.004** |
| Race and ethnicity (ref = non‐Hispanic White) | ||||||
| Black or African American | 1.13 | (0.69, 1.84) | 0.63 | 1.19 | (0.61, 2.30) | 0.61 |
| Hispanic | 0.47 | (0.28, 0.78) | 0.004** | 0.44 | (0.22, 0.90) | 0.02* |
| Asian | 0.47 | (0.11, 2.01) | 0.31 | 0.63 | (0.14, 2.78) | 0.54 |
| Other | 0.21 | (0.05, 0.88) | 0.03* | 0.34 | (0.08, 1.42) | 0.14 |
| Education (ref = college or advanced degree) | ||||||
| No college | 0.71 | (0.50, 1.02) | 0.06 | 1.17 | (0.73, 1.86) | 0.52 |
| Some college | 0.83 | (0.61, 1.13) | 0.23 | 0.96 | (0.65, 1.42) | 0.83 |
| Income (ref = over $100,000) | ||||||
| Under $50,000 | 0.74 | (0.53, 1.05) | 0.09 | 0.84 | (0.56, 1.26) | 0.41 |
| $50,000 to $100,000 | 1.14 | (0.80, 1.63) | 0.47 | 1.14 | (0.78, 1.65) | 0.50 |
FIGURE 2.
Forest plot of the adjusted odds ratio and 95% confidence interval for each variable in relation to voice care access in the Parkinson's disease cohort.
4. Discussion
Using the NIH All of Us Research Program, this study evaluated the prevalence of dysphonia, rates of speech evaluations and treatment, and potential healthcare disparities among PD patients. Of 1968 individuals with PD, 257 (13.1%) had a concomitant diagnosis of dysphonia. This is much lower than the expected prevalence of speech disorders in PD, which has been reported to be as high as 89% in a study by Logemann et al. [2]. This estimate included both dysarthria and dysphonia as the conditions are often difficult to parse apart. Although our study primarily focused on dysphonia and we did not attempt to distinguish between the two etiologies, we conducted a secondary analysis to ensure the discrepancy in prevalence was not due to our exclusion of dysarthria. Even after accounting for dysarthria, only 391 (19.9%) of individuals with PD had a diagnosis of either dysphonia or dysarthria. Thus, these results suggest that speech disorders are underrecognized and often do not lead to a formal diagnosis in PD patients.
Compared to individuals with non‐neurogenic dysphonia, the PD group had a significantly lower rate of voice care. Of 1968 PD patients, 264 (13.4%) received at least one diagnostic evaluation, defined as flexible laryngoscopy or speech evaluation. The incidence of speech evaluations is slightly greater than the prevalence of dysphonia, which may be due to dysarthria having a similar diagnostic workup. 124 (6.3%) PD patients received speech treatment, defined as vocal fold augmentation or SLT. As dysarthria contributes to hypophonia in PD, SLT for PD addresses both conditions and therefore can be used as a surrogate for voice therapy. 1683 of 1968 (85.5%) individuals in the PD cohort did not receive any voice care. This aligns with previous studies that indicate inadequate access to speech services among individuals with PD [31]. In particular, one study found that only 3%–4% of PD patients receive speech treatment [3], which is similar to the 6.3% reported in this study.
To explore potential disparities influencing voice care access and utilization, logistic regression analyses incorporating demographic and socioeconomic factors were conducted. Among individuals with PD, female sex and Hispanic ethnicity were associated with decreased odds of voice care based on unadjusted and adjusted models. No significant associations were observed between voice care and education level nor income. A previous investigation of neurologist care among PD patients revealed that women as well as racial and ethnic minorities obtained specialist care less often than White male counterparts [32]. In concordance with this, our study indicates that similar disparities may exist in access to specialized voice care for individuals with PD. Future research should validate these results and consider additional factors, such as undiagnosed speech disorders and delayed treatment, to achieve a more holistic evaluation of voice care disparities in PD patients.
This study has several limitations. Because this was an observational study, no causal relationships could be established. To minimize the impact of confounding, we performed adjusted logistic regression analyses that accounted for age, sex, race and ethnicity, education, and income. These variables encompass common social determinants of health but are by no means exhaustive, as many other factors may influence access to care, including other medical conditions and geographical location. Additionally, the study design was cross‐sectional, precluding analyses of long‐term speech outcomes in PD patients. Since ICD and CPT codes were used to determine diagnoses and interventions, self‐reported conditions and health records not captured in the database were not considered. To ensure that the low rate of voice care access in the PD group was not due to this methodology, we included the non‐neurogenic dysphonia group as a control. Furthermore, although CPT codes provided the most accurate means to determine voice care, we were unable to identify the specific indication behind speech evaluations or speech therapy, whether that be dysphonia, dysarthria, or another condition. Given that dysphonia and dysarthria are often coexistent and diagnostically interlinked [2, 13, 25], relying on ICD codes may have led to an inaccurate estimation of the prevalence of true dysphonia. Overestimation of the rates of voice care is also possible due to selection bias, as the All of Us Research Program often recruits participants already engaged in healthcare and medical systems. Despite these limitations, our study represents the first endeavor, to our knowledge, to evaluate the prevalence and management of dysphonia in PD on a national scale.
In summary, using the NIH All of Us database, 13.1% of individuals with PD had a formal diagnosis of dysphonia. 13.4% of individuals with PD underwent at least one diagnostic speech evaluation and 6.3% received at least one form of speech treatment. Considering the strong consensus in the literature that PD commonly presents with speech problems [3, 11], these findings indicate insufficient recognition and management of speech disorders in PD patients. Standard PD treatments, including dopaminergic medications and DBS, rarely alleviate speech impairments and can even accelerate deterioration [10, 11, 12, 13, 14]. Instead, SLT and vocal fold augmentation serve as evidence‐based treatments to manage speech concerns [15, 16, 17, 18, 19, 20, 21]. Vocal fold augmentation is an effective procedural approach to lessen vocal fold bowing and promote glottic closure, although its benefit is temporary [15]. SLT offers long‐term enhancements in multiple areas of speech, including increased volume levels and perceptual intelligibility, and has a larger body of evidence supporting its application in PD patients [16, 17, 18, 19, 20, 21]. Both treatments highlight the potential value of involving otolaryngologists and speech‐language pathologists in the care of PD patients. Unlike many other neurological causes of speech disorders, PD's slow and progressive nature offers a unique opportunity for early intervention that could prevent further deterioration and lead to robust improvements [7, 20]. Alterations in communication significantly reduce quality of life and are intricately linked to cognition and social interaction [8, 9]. In fact, a survey of PD patients revealed that 29% considered speech issues as one of their greatest problems [33]. Altogether, this study demonstrates that diagnosing and treating speech disorders is a crucial but often overlooked aspect of multidisciplinary PD management.
5. Conclusions
PD commonly presents with speech and voice disorders. However, using a national database, only 13.1% of individuals with PD had a formal dysphonia diagnosis, and only 6.3% received speech treatment. Female sex and Hispanic ethnicity predicted decreased voice care among PD patients. These findings suggest the underrecognition and undertreatment of dysphonia in PD.
Conflicts of Interest
The authors declare no conflicts of interest.
Supporting information
Table S1. ICD‐9 and ICD‐10 codes used to determine diagnoses in study.
Table S2. CPT codes used to determine voice care in study.
Acknowledgments
We gratefully acknowledge All of Us participants, without whom this research would not have been possible. We also thank the National Institutes of Health's All of Us Research Program for making the participant data examined in this study available.
Funding: The authors received no specific funding for this work.
Abstract has been submitted to the Triological Society Annual Meeting at COSM in New Orleans, Louisiana occurring May 14–18, 2025.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Table S1. ICD‐9 and ICD‐10 codes used to determine diagnoses in study.
Table S2. CPT codes used to determine voice care in study.