Association of Dysphonia in Patients with Dysphagia in the United States: A National Database Study

Linh He; Robin Zhao; James Curtis; Camonia Graham-Tutt; Anaïs Rameau

doi:10.1002/lary.32239

. Author manuscript; available in PMC: 2026 May 3.

Published in final edited form as: Laryngoscope. 2025 May 3;135(9):3248–3256. doi: 10.1002/lary.32239

Association of Dysphonia in Patients with Dysphagia in the United States: A National Database Study

Linh He ^1,^*, Robin Zhao ^1,^*, James Curtis ¹, Camonia Graham-Tutt ², Anaïs Rameau ¹

PMCID: PMC12353530 NIHMSID: NIHMS2080260 PMID: 40317750

Abstract

Objective:

Limited research exists on the prevalence and comorbidity of dysphagia and dysphonia, though prior studies highlight their co-existence in multiple disease cohorts. This study investigates the prevalence of dysphonia in U.S. adults with dysphagia.

Methods:

A cross-sectional study was conducted using the NIH’s All of Us Research Program controlled tier dataset (version 7). Multivariate logistic regression and marginal effects examined the association of dysphonia in U.S. adults with dysphagia.

Results:

Among 266,612 adults, 24,198 had dysphagia (median age, 67 years; 63% female), and 242,414 did not (median age, 58 years; 61% female). Dysphonia was significantly more prevalent in patients with dysphagia (14% vs. 1.9%, P<.001). Multivariate analysis showed a 6.78-fold increase in odds of dysphonia with dysphagia (95% CI 6.47–7.11; marginal effects [ME], 9.82%). Dysphagia was significantly associated with dysphonia in patients with head and neck cancer (aOR 2.93; ME 13.51%), stroke (aOR 3.71; ME 14.56%), neurodegenerative conditions (aOR 4.34; ME 13.16%), COPD (aOR 4.33; ME 13.35%), ACDF (aOR 5.24; ME 18.90%), and vocal fold abnormalities (aOR 1.40; ME 7.71%).

Conclusion:

Patients with dysphagia had a 6.78-fold increase in odds of having a diagnosis of dysphonia. Otolaryngologists and speech language pathologists should consider dysphonia assessment in their patients presenting with dysphagia.

Level of Evidence:

Keywords: Dysphagia, Dysphonia, Laryngology

Graphical Abstract:

This study investigates the association between dysphagia and dysphonia across diverse patient populations, including those with stroke, neurodegenerative conditions, respiratory disorders, and structural impairments. Findings highlight shared anatomical and pathophysiological mechanisms underlying these conditions, with disease-specific factors driving variations in their relationship.

Introduction:

Dysphonia not only disrupts communication but may also reflect underlying laryngeal or systemic dysfunctions. It can arise from various causes, including structural abnormalities, neurological impairments, and inflammatory conditions, making its evaluation critical in clinical practice.^1–3 Similarly, dysphagia is another condition that profoundly affects quality of life, and is associated with poor outcomes, including malnutrition, frailty, and aspiration pneumonia.^4–6 Both conditions, though distinct, share critical anatomical and functional domains within the larynx, making it important to better understand how they are related.⁷

Several studies have demonstrated the co-occurrence of dysphagia and dysphonia, suggesting that structural and sensory changes from neurological disorders, cancer treatments, or laryngeal impairments often link these conditions.^8–12 However, few studies have investigated the broader relationship between dysphonia and dysphagia. This study addresses this gap by examining dysphonia as an associated condition among patients with dysphagia across diverse comorbidities and demographic groups.

Our study assesses the prevalence and predictors of dysphonia in patients with dysphagia in the United States using data from the NIH All of Us Research Program. By examining a variety of conditions, including stroke, head and neck cancer, neurodegenerative disorders, chronic obstructive pulmonary disease (COPD), and vocal fold abnormalities, we aim to analyze the patterns and predictors of dysphonia in patients with dysphagia.

Methods

This cross-sectional study utilized electronic health record data from adult patients enrolled in the All of Us Research Program between May 31, 2017, and July 1, 2022 (All of Us controlled tier dataset, version 7).¹³ The NIH All of Us Research Program contains a diverse dataset that includes electronic health records, survey responses, genetic information, physical measurements, and wearable device data from patients across the United States.¹⁴ All U.S. adults aged 18 years or older who can provide consent are eligible for the study, with participants enrolling either online or through partner healthcare organizations across the United States.¹⁴

Patients with dysphagia were identified in the data set using the following ICD-9 codes (787.20, 787.21, 787.22, 787.23, 787.24, 787.29, 530.0, 530.3, 530.5, 530.6, 530.13) and ICD-10 codes (R13.10, R13.11, R13.12, R13.13, R13.14, R13.19). Comorbidities associated with dysphagia were also included: dysphonia, cancer in the oral cavity, pharynx, nasopharynx, or esophagus, thyroid cancer, thyroid surgery, parathyroid surgery, skull base tumor, stroke, dementia, Parkinson’s disease, multiple sclerosis, amyotrophic lateral sclerosis (ALS), muscular dystrophy, polymyositis, dermatomyositis, inclusion body myositis, chronic obstructive lung disease (COPD), history of anterior cervical discectomy and fusion (ACDF), vocal nodules, cysts, or polyps, edema of vocal cord, glottal stenosis, recurrent respiratory papillomatosis, sarcopenia, recurrent laryngeal nerve paralysis, and spasmodic dysphonia. More detailed information on the ICD and Systematized Nomenclature of Medicine (SNOMED) codes for the comorbidities are available in Supplementary Table 1. We further categorized comorbidities into six categories: head and neck cancer, stroke, neurodegenerative diseases, COPD, history of ACDF, and vocal fold abnormalities. The category details can be found in Supplementary Table 1.

Demographic information was also collected, including age, sex, and race and ethnicity (Table 1). Sex was determined by the patient’s sex assigned at birth. Adults were grouped according to their race and ethnicity: Hispanic, non-Hispanic White, non-Hispanic Asian, non-Hispanic Black, and non-Hispanic other. The “other” category includes those who answered “more than one,” “other,” “skip,” and “prefer not to answer.” (Table 1).

Table 1.

Characteristics of the Study Population With and Without Dysphagia

Characteristic	Overall N = 266,612¹	Patients with dysphagia N = 24,198¹	Patients without dysphagia N = 242,414¹	p-value²
Age	59 (43, 71)	67 (56, 76)	58 (42, 70)	<0.001
Sex
Female	162,059 (61%)	15,296 (63%)	146,763 (61%)	<0.001
Male	99,153 (37%)	8,304 (34%)	90,849 (37%)
Other	5,400 (2.0%)	598 (2.5%)	4,802 (2.0%)
Race & Ethnicity
White	141,694 (53%)	14,742 (61%)	126,952 (52%)	<0.001
Asian	7,384 (2.8%)	362 (1.5%)	7,022 (2.9%)
Black	52,877 (20%)	4,213 (17%)	48,664 (20%)
Hispanic	48,664 (18%)	3,397 (14%)	45,267 (19%)
Other	15,993 (6.0%)	1,484 (6.1%)	14,509 (6.0%)
Dysphonia	8,127 (3.0%)	3,423 (14%)	4,704 (1.9%)	<0.001
Cancer in oral cavity, pharynx, nasopharynx, or esophagus	483 (0.2%)	328 (1.4%)	155 (<0.1%)	<0.001
Thyroid cancer	2,341 (0.9%)	570 (2.4%)	1,771 (0.7%)	<0.001
Thyroid surgery	425 (0.2%)	115 (0.5%)	310 (0.1%)	<0.001
Parathyroid surgery	58 (<0.1%)	<20 (<0.1%)	47 (<0.1%)	0.009
Skull base tumor	186 (<0.1%)	75 (0.3%)	111 (<0.1%)	<0.001
Stroke	11,594 (4.3%)	3,099 (13%)	8,495 (3.5%)	<0.001
Dementia	5,441 (2.0%)	1,474 (6.1%)	3,967 (1.6%)	<0.001
Parkinson’s disease	1,915 (0.7%)	626 (2.6%)	1,289 (0.5%)	<0.001
Multiple sclerosis	2,685 (1.0%)	532 (2.2%)	2,153 (0.9%)	<0.001
Amyotrophic lateral sclerosis	165 (<0.1%)	80 (0.3%)	85 (<0.1%)	<0.001
Muscular dystrophy	814 (0.3%)	255 (1.1%)	559 (0.2%)	<0.001
Polymyositis	302 (0.1%)	123 (0.5%)	179 (<0.1%)	<0.001
Dermatomyositis	315 (0.1%)	117 (0.5%)	198 (<0.1%)	<0.001
Inclusion body myositis	46 (<0.1%)	25 (0.1%)	21 (<0.1%)	<0.001
Chronic obstructive lung disease	23,025 (8.6%)	5,525 (23%)	17,500 (7.2%)	<0.001
History of anterior cervical discectomy and fusion (ACDF)	478 (0.2%)	165 (0.7%)	313 (0.1%)	<0.001
Vocal nodules, cysts, or polyps	560 (0.2%)	237 (1.0%)	323 (0.1%)	<0.001
Edema of vocal cord	958 (0.4%)	483 (2.0%)	475 (0.2%)	<0.001
Glottal stenosis	183 (<0.1%)	88 (0.4%)	95 (<0.1%)	<0.001
Recurrent respiratory papillomatosis	<20 (<0.1%)	<20 (<0.1%)	<20 (<0.1%)	0.044
Sarcopenia	66 (<0.1%)	21 (<0.1%)	45 (<0.1%)	<0.001
Recurrent laryngeal nerve paralysis	1,443 (0.5%)	722 (3.0%)	721 (0.3%)	<0.001
Spasmodic dysphonia	<20 (<0.1%)	<20 (<0.1%)	<20 (<0.1%)	0.006

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Median (Q1,Q3); n (%); in accordance with the National Institutes of Health All of Us Research Program data and statistics dissemination policy, all values of fewer than 20 individuals are reported as such to protect the privacy of participants.

Wilcoxon rank sum test; Pearson’s Chi-squared test; Fisher’s exact test

Statistical Analysis

Multivariate logistic regression and marginal effects were used to study the association of dysphagia with dysphonia. All multivariate regression models were adjusted for age and sex. We included only age and sex in our analyses, excluding variables such as race, ethnicity, and additional comorbidities. These factors were excluded because they are more likely to act as mediators rather than confounders, potentially obscuring the direct effect of dysphagia on the outcomes by controlling for pathways through which dysphagia exerts its influence. Mediators are variables that lie on the causal pathway between the exposure and the outcome, while confounders are variables that are associated with both the exposure and the outcome but are not part of the causal pathway.

To assess the robustness of our model and challenge the above assumption about mediator effect, we additionally performed a sensitivity analysis by sequentially adding race/ethnicity and major comorbidities (head and neck cancer, stroke, neurodegenerative disease, COPD, ACDF, and vocal fold abnormalities) to the models. This analysis was repeated for both the unmatched and propensity score matched datasets.

Descriptive statistics, Wilcoxon rank sum test, Pearson’s Chi-squared test, Fisher’s exact test, and table generation were performed using R version 4.3.2 (R Foundation for Statistical Computing, Vienna, Austria, 2023).¹⁵ Regression models and marginal effects analyses were conducted on seven subgroups: the entire patient cohort, patients with head and neck cancer, patients with stroke, patients with neurodegenerative diseases, patients with COPD, patients with a history of ACDF, and patients with vocal fold abnormalities. A p-value of less than 0.05 was considered statistically significant.

Results

Our study included 266,612 adult patients in the NIH’s All of Us Research Program controlled tier data set version 7. Among the adult patient cohort, 24,198 patients had dysphagia based on ICD-9 and ICD-10 codes (median age, 67 years; interquartile range (IQR), 56–76 years; 15,296 [63%] assigned female sex and 8,304 [34%], male sex at birth; 3,397 [14%], Hispanic/Latino; 362 [1.5%], non-Hispanic Asian; 4,213 [17%], non-Hispanic Black; 14,742 [61%], non-Hispanic White; 1,484 [6.1%], other) and 242,414 patients did not have dysphagia (median age, 58 years [IQR, 42–70 years]; 146,763 [61%] assigned female sex and 90,849 [37%], male sex at birth; 45,267 [19%], Hispanic/Latino; 7,022 [2.9%], non-Hispanic Asian; 48,664 [20%], non-Hispanic Black; 126,952 [52%], non-Hispanic White; 14,509 [6.0%], other). Table 1 summarizes the descriptive characteristics and comorbidities of the adult patient cohort. Dysphonia (prevalence among dysphagia patients, 3,423 [14%]; non-dysphagia, 4,704 [1.9%]), stroke (dysphagia, 3,099 [13%]; non-dysphagia, 8,495 [3.5%]), and COPD (dysphagia, 5,525 [23%]; non-dysphagia, 17,500 [7.2%]) were among the most common comorbidities in dysphagia patients (Table 1).

Tables 2–8 and Supplementary Tables 2–8 summarize the univariate and multivariate logistic regression and marginal effects models of dysphagia associated with dysphonia. After adjusting for age and sex, dysphagia was significantly associated with dysphonia in the entire patient cohort (adjusted odds ratio [aOR], 6.78; confidence interval [CI], 6.47–7.11) (Table 2). In addition, the probability of dysphonia increases by 9.82% when dysphagia is present, accounting for other variables like age and sex, in the whole patient cohort (Supplementary Table 2). Further subgroup analyses found that among patients with head and neck cancer, dysphagia continues to be significantly associated with dysphonia (aOR, 2.93; CI, 2.37–3.62; marginal effects (ME), 13.51%) (Table 3 and Supplementary Table 3). Dysphagia is also found to be significantly associated with dysphonia among patients with stroke (aOR, 3.71; CI, 3.29–4.19; ME, 14.56%), patients with neurodegenerative conditions (aOR, 4.34; CI, 3.77–4.99; ME, 13.16%), patients with COPD (aOR, 4.33; CI, 3.93–4.77; ME, 13.35%), patients with ACDF (aOR, 5.24; CI, 2.95–9.63; ME, 18.90%), and patients with vocal fold abnormalities (aOR, 1.40; CI, 1.20–1.63; ME, 7.71%) (Tables 4–8 and Supplementary Tables 4–8).

Table 2.

Univariable and Multivariable Logistic Regression Analysis Assessing the Association Between Dysphagia and Dysphonia in the Entire Patient Cohort

	Univariable analysis			Multivariable analysis
Characteristic	OR¹	95% CI¹	p-value	OR¹	95% CI¹	p-value
Dysphagia
Patients without dysphagia	1 [Reference]			1 [Reference]
Patients with dysphagia	8.33	7.95, 8.72	<0.001	6.78	6.47, 7.11	<0.001

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OR = Odds Ratio, CI = Confidence Interval

Table 8.

Univariable and Multivariable Logistic Regression Analysis Assessing the Association Between Dysphagia and Dysphonia in Patients with Vocal Fold Abnormalities

	Univariable analysis			Multivariable analysis
Characteristic	OR¹	95% CI¹	p-value	OR¹	95% CI¹	p-value
Dysphagia
Patients without dysphagia	1 [Reference]			1 [Reference]
Patients with dysphagia	1.40	1.20, 1.63	<0.001	1.40	1.20, 1.63	<0.001

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OR = Odds Ratio, CI = Confidence Interval

Table 3.

Univariable and Multivariable Logistic Regression Analysis Assessing the Association Between Dysphagia and Dysphonia in Patients with Head and Neck Cancer

	Univariable analysis			Multivariable analysis
Characteristic	OR¹	95% CI¹	p-value	OR¹	95% CI¹	p-value
Dysphagia
Patients without dysphagia	1 [Reference]			1 [Reference]
Patients with dysphagia	2.95	2.40, 3.63	<0.001	2.93	2.37, 3.62	<0.001

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OR = Odds Ratio, CI = Confidence Interval

Table 4.

Univariable and Multivariable Logistic Regression Analysis Assessing the Association Between Dysphagia and Dysphonia in Patients with Stroke

	Univariable analysis			Multivariable analysis
Characteristic	OR¹	95% CI¹	p-value	OR¹	95% CI¹	p-value
Dysphagia
Patients without dysphagia	1 [Reference]			1 [Reference]
Patients with dysphagia	3.76	3.34, 4.25	<0.001	3.71	3.29, 4.19	<0.001

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OR = Odds Ratio, CI = Confidence Interval

Supplementary Tables 9–25 summarize the sensitivity analyses and propensity score matching analyses in which additional covariates of race/ethnicity and comorbidities, were sequentially added to the multivariate logistic regression models. Across both the unmatched and matched datasets, the association between dysphagia and dysphonia remained statistically significant (p < 0.001), supporting the robustness of our primary findings.

Discussion:

In this study, we investigated dysphonia as an associated condition in patients with dysphagia within a large and diverse population cohort. Using data from the NIH’s All of Us Research Program, we examined the prevalence of dysphonia in dysphagia patients, their demographic distribution, and the comorbidities influencing its development. Overall, our study demonstrates that dysphonia is a significant burden in patients with dysphagia, particularly among disease cohorts with a high prevalence of dysphagia.

Demographic and Prevalence

Consistent with other studies, our results show that patients with dysphagia were notably older, White-identifying, and predominantly female.^16–20 The finding that dysphonia was significantly more common among patients with dysphagia (14% vs. 1.9%) highlights the shared anatomical pathways involving phonation and swallowing. These pathways include neuromuscular and sensory mechanisms that link dysfunctions in these regions to concurrent voice and swallowing impairments.^8,21

Age and sex are important factors in the relationship between dysphonia and dysphagia, with studies showing that older adults and females are more susceptible due to age-related declines in muscle function and sex-based anatomical differences.^22–24 In the overall dataset, age and sex had a pronounced effect on the change in the probability of dysphonia as an outcome in patients with dysphagia. This was evidenced by a notable decrease in the probability of dysphonia (from 12.21% to 9.82%) after adjusting for these demographic factors (Supplementary Table 2). The effect of age and sex may reflect the broad variability and influence of these factors in a heterogeneous population. However, in specific disease cohorts, adjusting for age and sex had a smaller effect, suggesting that the primary drivers of dysphagia and dysphonia are the pathophysiological mechanisms inherent to each condition.

Stroke and Neurodegenerative Disorders

Patients with stroke exhibited a robust association between dysphonia and dysphagia, likely due to impairments in sensation and neuromuscular coordination that affect both functions. Stroke often results in vocal fold paralysis, disrupting phonation and protective airway mechanisms, and impairing the synchronization required for safe swallowing.^25–33 Furthermore, studies show that interventions like neuromuscular electrical stimulation can simultaneously improve vocal quality and laryngeal elevation needed for swallowing, underscoring the shared neuromuscular pathways involved.^34–36

For patients with neurodegenerative conditions such as Parkinson’s disease, amyotrophic lateral sclerosis (ALS), or multiple sclerosis (MS), dysphagia was also associated with dysphonia. However, the association was slightly lower compared to stroke. Given that the relationship between dysphonia and dysphagia within neurodegenerative disease is driven by progressive laryngeal and pharyngeal muscle dysfunction, this could perhaps, reflect a more gradual onset of impairments, allowing patients to develop compensatory adaptations over time.³⁷ Nevertheless, studies consistently demonstrate that reduced voice intensity and deteriorated swallowing function are closely linked in patients with Parkinson’s disease and other neurodegenerative disorders.^{21, 38} For instance, a recent high-resolution video manometry study supported this association in Parkinson’s disease by identifying critical impairments in laryngeal elevation and esophageal function.³⁹ Other neurodegenerative conditions such as MS and ALS also exhibit significant associations between dysphagia and dysphonia. For instance, voice assessments in patients with MS have revealed distinct patterns, which may help predict dysphagia risk.^{40, 41} Similarly, both dysphonia and dysphagia have been implicated in ALS, with studies highlighting the overlapping dysfunction in glottic competence and upper esophageal sphincter function, critical for both voice and swallowing.^{42, 43}

The strong associations of both dysphonia and dysphagia in stroke and neurodegenerative disorders come as no surprise, given the well-known overlap in therapeutic interventions. Interventions like Lee Silverman Voice Treatment (LSVT LOUD^®) and Effortful Pitch Glides have shown promise in improving both vocal and swallowing outcomes.^44–48 Therapies such as systematic voice training, semi-occluded vocal tract exercises, and therapeutic singing have shown promise for addressing neuromuscular coordination deficits in patients with stoke and neurodegenerative diseases.⁴⁴ These integrated therapeutic approaches highlight the interconnected nature of voice and swallowing impairments and offer promising strategies to improve patient outcomes and quality of life.

Structural and Surgical Factors

Among patients with head and neck cancer, dysphagia was strongly associated with dysphonia, which is consistent with prior studies.^9,10,49,50 Cancer treatments such as surgery and radiation often lead to fibrosis and neuropathy, which disrupt the structural and functional integrity of the larynx and pharynx. Early intervention focusing on both voice and swallowing rehabilitation may improve outcomes in this patient population.^51,52

In patients with a history of ACDF, the relationship between dysphagia and dysphonia was particularly pronounced with these patients being more than five times as likely to develop dysphonia (Table 7). This strong association may result from surgical impacts on cervical spine alignment and recurrent laryngeal nerve integrity.⁵³ In addition, vocal fold palsy and swallowing issues are commonly reported postoperatively, especially in revision or multilevel procedures.^{54, 55}

Table 7.

Univariable and Multivariable Logistic Regression Analysis Assessing the Association Between Dysphagia and Dysphonia in Patients with a History of Anterior Cervical Discectomy and Fusion

	Univariable analysis			Multivariable analysis
Characteristic	OR¹	95% CI¹	p-value	OR¹	95% CI¹	p-value
Dysphagia
Patients without dysphagia	1 [Reference]			1 [Reference]
Patients with dysphagia	5.12	2.89, 9.34	<0.001	5.24	2.95, 9.63	<0.001

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OR = Odds Ratio, CI = Confidence Interval

Conversely, patients with vocal fold abnormalities showed a significant but smaller association between dysphagia and dysphonia (Table 8). Laryngeal pathology may affect swallowing function through glottic insufficiency and changes in cough efficiency. How this may impact swallowing function remains understudied, with conflicting findings in the literature.⁵⁶ Laryngeal conditions like vocal fold paralysis or atrophy can cause glottic insufficiency, impairing airway protection and contributing to aspiration risk.^57–59 Hamdan et al. found high rates of dysphagia in patients with vocal fold pathology and attributed this co-occurrence to disruptions in coordinated neuromuscular activity involving the larynx and pharynx—specifically, laryngeal elevation, pharyngeal contraction, and upper esophageal sphincter function.⁶⁰

Respiratory Disorders

Our findings show that patients with COPD demonstrated a significant association between dysphagia and dysphonia. In patients with COPD, dysphagia may be associated with dysphonia due to overlapping pulmonary pathophysiological mechanisms that affect both swallowing and voice production. Disruptions in the coordination of swallowing and ventilation, such as increased swallowing during inspiration or during transitions from inspiration to expiration, can exacerbate the risk of aspiration and swallowing dysfunction in patients with COPD.⁶¹ Additionally, reduced pulmonary function in COPD, has been directly correlated with diminished vocal function, including reduced maximum phonation time and phonatory efficiency.⁶¹ The decline in respiratory capacity may also contribute to respiratory muscle fatigue, which disrupts the coordination between breathing and swallowing, increasing the risks of aspiration and dysphonia.^61–,63

Integrated pulmonary rehabilitation programs, which combine dysphagia interventions and respiratory therapy, have shown significant improvements in swallowing-related quality of life and disease management.⁶⁴ Similarly, voice therapy tailored to address vocal fold inflammation related to inhaler use or chronic cough in patients with COPD, may help improve voice quality.^64–67

Breath support exercises, central to voice therapy, improve coordination between respiratory and phonatory systems and are particularly useful for optimizing phonation in patients with COPD.⁶¹ By addressing these interconnected challenges, integrated therapeutic approaches can significantly enhance outcomes and quality of life for patients with COPD experiencing both dysphagia and dysphonia.

Limitations

Our study is not without its limitations. First, while the All of Us Research Program data set contains a large and diverse cohort, the results may not be representative of the U.S. adult population. Second, our study relies on electronic health record diagnoses and ICD and SNOMED codes, which may not always be accurate or complete. Diagnoses could vary in precision depending on the clinician’s specialty or expertise, and validation of these diagnoses is not included. Third, our analysis only adjusts for age and sex, excluding variables such as race, ethnicity, and additional comorbidities. While this approach avoids potential mediation bias, it may overlook confounding effects that could influence the observed associations. Fourth, although income is captured in the All of Us dataset, we did not assess it in this study. Socioeconomic factors like income may impact access to care and diagnostic patterns and should be explored in future analyses. Lastly, the All of Us dataset does not include treatment data of patients, such as therapies for dysphagia or dysphonia. This omission may prevent a more detailed analysis of the impact of dysphagia and dysphonia treatment. As such, there is a need for future studies to incorporate treatment data to evaluate the effectiveness of dysphagia and dysphonia treatment and to better understand the impact of treatment on patient outcomes.

Conclusion:

Our study highlights the significant association between dysphagia and dysphonia across diverse patient populations, driven by shared anatomical and pathophysiological mechanisms. We show that while demographic factors like age and sex influence the broader population, the association between dysphagia and dysphonia is particularly pronounced in some disease subgroups with a high prevalence of dysphagia. Moreover, our study highlights the need for future research to further elucidate the causal mechanisms linking dysphagia and dysphonia in specific diseases and to explore targeted therapies. Overall, our findings emphasize the interplay between dysphagia and dysphonia across diverse patient populations and may inform the development of overlapping diagnostic and therapeutic approaches.

Supplementary Material

Supinfo

Supplementary Table 1. ICD and Systematized Nomenclature of Medicine (SNOMED) Codes and Subgroups for the Comorbidities

Supplementary Table 2. Marginal Effects Model Assessing the Probability of Dysphonia When Dysphonia is Present in the Entire Patient Cohort

Supplementary Table 3. Marginal Effects Model Assessing the Probability of Dysphonia When Dysphonia is Present in Patients with Head and Neck Cancer

Supplementary Table 4. Marginal Effects Model Assessing the Probability of Dysphonia When Dysphonia is Present in Patients with Stroke

Supplementary Table 5. Marginal Effects Model Assessing the Probability of Dysphonia When Dysphonia is Present in Patients with Neurodegenerative Conditions

Supplementary Table 6. Marginal Effects Model Assessing the Probability of Dysphonia When Dysphonia is Present in Patients with Chronic Obstructive Lung Disease

Supplementary Table 7. Marginal Effects Model Assessing the Probability of Dysphonia When Dysphonia is Present in Patients with a History of Anterior Cervical Discectomy and Fusion

Supplementary Table 8. Marginal Effects Model Assessing the Probability of Dysphonia When Dysphonia is Present in Patients with Vocal Fold Abnormalities

Supplementary Table 9: Sensitivity Analysis with Stepwise Covariate Adjustments in Unmatched Cohort

Supplementary Table 10: Sensitivity Analysis with Stepwise Covariate Adjustments in Matched Cohort

Supplementary Table 11: Characteristics of the Propensity Score Matched Study Population With and Without Dysphagia

Supplementary Table 12: Univariable and Multivariable Logistic Regression Analysis Assessing the Association Between Dysphagia and Dysphonia in the Entire Patient Cohort of the Propensity Score Matched Cohort

Supplementary Table 13: Marginal Effects Model Assessing the Probability of Dysphonia When Dysphonia is Present in the Entire Patient Cohort of the Propensity Score Matched Cohort

Supplementary Table 14: Univariable and Multivariable Logistic Regression Analysis Assessing the Association Between Dysphagia and Dysphonia in Patients with Head and Neck Cancer of the Propensity Score Matched Cohort

Supplementary Table 15: Marginal Effects Model Assessing the Probability of Dysphonia When Dysphonia is Present in Patients with Head and Neck Cancer of the Propensity Score Matched Cohort

Supplementary Table 16: Univariable and Multivariable Logistic Regression Analysis Assessing the Association Between Dysphagia and Dysphonia in Patients with Stroke of the Propensity Score Matched Cohort

Supplementary Table 17: Marginal Effects Model Assessing the Probability of Dysphonia When Dysphonia is Present in Patients with Stroke of the Propensity Score Matched Cohort

Supplementary Table 18: Univariable and Multivariable Logistic Regression Analysis Assessing the Association Between Dysphagia and Dysphonia in Patients with Neurodegenerative Conditions of the Propensity Score Matched Cohort

Supplementary Table 19: Marginal Effects Model Assessing the Probability of Dysphonia When Dysphonia is Present in Patients with Neurodegenerative Conditions of the Propensity Score Matched Cohort

Supplementary Table 20: Univariable and Multivariable Logistic Regression Analysis Assessing the Association Between Dysphagia and Dysphonia in Patients with Chronic Obstructive Lung Disease of the Propensity Score Matched Cohort

Supplementary Table 21: Marginal Effects Model Assessing the Probability of Dysphonia When Dysphonia is Present in Patients with Chronic Obstructive Lung Disease of the Propensity Score Matched Cohort

Supplementary Table 22: Univariable and Multivariable Logistic Regression Analysis Assessing the Association Between Dysphagia and Dysphonia in Patients with a History of Anterior Cervical Discectomy and Fusion of the Propensity Score Matched Cohort

Supplementary Table 23: Marginal Effects Model Assessing the Probability of Dysphonia When Dysphonia is Present in Patients with a History of Anterior Cervical Discectomy and Fusion of the Propensity Score Matched Cohort

Supplementary Table 24: Univariable and Multivariable Logistic Regression Analysis Assessing the Association Between Dysphagia and Dysphonia in Patients with Vocal Fold Abnormalities of the Propensity Score Matched Cohort

Supplementary Table 25: Marginal Effects Model Assessing the Probability of Dysphonia When Dysphonia is Present in Patients with Vocal Fold Abnormalities of the Propensity Score Matched Cohort

NIHMS2080260-supplement-Supinfo.docx^{(46.2KB, docx)}

Table 5.

Univariable and Multivariable Logistic Regression Analysis Assessing the Association Between Dysphagia and Dysphonia in Patients with Neurodegenerative Conditions

	Univariable analysis			Multivariable analysis
Characteristic	OR¹	95% CI¹	p-value	OR¹	95% CI¹	p-value
Dysphagia
Patients without dysphagia	1 [Reference]			1 [Reference]
Patients with dysphagia	4.64	4.04, 5.33	<0.001	4.34	3.77, 4.99	<0.001

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OR = Odds Ratio, CI = Confidence Interval

Table 6.

Univariable and Multivariable Logistic Regression Analysis Assessing the Association Between Dysphagia and Dysphonia in Patients with Chronic Obstructive Lung Disease

	Univariable analysis			Multivariable analysis
Characteristic	OR¹	95% CI¹	p-value	OR¹	95% CI¹	p-value
Dysphagia
Patients without dysphagia	1 [Reference]			1 [Reference]
Patients with dysphagia	4.56	4.14, 5.02	<0.001	4.33	3.93, 4.77	<0.001

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OR = Odds Ratio, CI = Confidence Interval

Financial Support or Funding:

Anaïs Rameau was supported by a Paul B. Beeson Emerging Leaders Career Development Award in Aging (K76 AG079040) from the National Institute on Aging and by the Bridge2AI award (OT2 OD032720) from the NIH Common Fund. Robin Zhao was supported by the AIM-AHEAD: Traineeship in Advanced Data Analytics (3OT2OD032581-01S1-665).

Footnotes

Conflict of Interest Statement: Anaïs Rameau owns equity of Perceptron Health, Inc. Anaïs Rameau is an advisor for Sound Health Systems, Inc and Pentax Medical.

Meeting Information: Oral Presentation at the 2025 Triological Combined Sections Meeting in Orlando, FL, USA, January 23–25, 2025.

References:

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