Refining a multimedia patient-reported outcomes measure for patients with low literacy.

Laryngeal symptoms are highly prevalent in the general population and represent a substantial public health burden. In 2012, population‐based studies estimated that voice disorders affect approximately 6%–9% of adults at any given time and up to 30% of individuals across the lifespan [, , ]. In 2022, the number of annually reported voice problems among Americans increased to 12.2% of the population, with higher prevalence among women, older adults, professional voice users and individuals with medical and psychological comorbidities []. Because many laryngeal disorders lack a single objective biomarker and symptom severity often correlates poorly with laryngoscopic findings, patient reported outcome measures (PROMs) have been central to laryngologic evaluation. Instruments such as the voice handicap index‐10 (VHI‐10) and the reflux symptoms index (RSI) provide standardized measurements of perceived voice handicap and reflux symptoms, respectively, and are widely used for screening, severity stratification, treatment selection and longitudinal monitoring of therapeutic response [, , ]. The interplay of socioeconomic and environmental stressors may amplify both exposure risk and physiologic vulnerability, thus contributing to disparities in prevalence, severity and subjective impact of laryngeal symptoms across patient populations []. Social determinants of health (SDoH), defined as the conditions in which people are born, grow, live, work and age, play a central role in shaping health outcomes, healthcare access and disease burden across populations []. The World Health Organization (WHO) has long recognized SDoH as a primary driver of health inequities worldwide, influencing morbidity, mortality and quality of life through structural, economic and environmental mechanisms []. In the United States, socioeconomic disadvantage has been consistently linked to delayed access to care, increased disease severity at presentation and poorer patient‐reported outcomes across multiple medical and surgical subspecialties [, , ]. Within otolaryngology, healthcare disparities have been described in head and neck cancer outcomes, pediatric airway disease, hearing loss, and sleep‐disordered breathing [, , ]. Despite the centrality of PROMs in clinical laryngology, the influence of neighborhood‐level socioeconomic context on patient‐reported laryngeal symptom burden remains under‐characterized. Multi‐level equity sciences is a novel approach to addressing health disparities, considering both individual‐level and exposome impacts on wellbeing []. These direct and cumulative biologic effects on human physiology through chronic activation of stress response pathways are a phenomenon termed allostatic load [, ]. Though SDoH is widely recognized as a driver of health inequities on an individual level, neighborhood‐level socioeconomic deprivation is a powerful underlying factor in the pathophysiologic impact of these stressors leading to increased allostatic load. Area deprivation index (ADI) is a validated, census‐based composite measure that quantifies neighborhood disadvantage using income, education, employment and housing quality metrics. Higher ADI is associated with elevated biologic stress markers of allostatic load, making it not only a proxy for access to care, but also a surrogate for cumulative biologic stress exposure that may directly shape expression and symptom perception [, , ].