Geographic Clustering of Idiopathic Subglottic Stenosis in North America: An Ecological Cohort Study
5 affiliations
- 1University of Michigan Medical School, University of Michigan
- 2University of Michigan Ross School of Business, University of Michigan
- 3Dalhousie University
- 4University of Calgary
- 5University of Michigan
Abstract
Background Idiopathic subglottic stenosis (iSGS) is a recurrent fibroinflammatory narrowing of the subglottis, typically affecting White pre‐ and perimenopausal women. While its etiology remains uncertain, inflammatory signaling, reflux, hormonal influences, and mycobacterial factors have been proposed. This study evaluated geographic variability in survey‐ascertained iSGS prevalence, exploring potential environmental correlates associated with regional disease distribution. Methods A retrospective ecological analysis of self‐reported demographic and clinical data from members of an international iSGS online support group was performed. Responses were analyzed by continent, country, and US state or Canadian province. Estimated prevalence per 1,000,000 White females was calculated using census data and examined in relation to environmental and access‐related factors, including temperature, humidity, and particulate matter. Results Among 4450 survey respondents, 99.3% were female and 83.8% reported symptom onset after age 30. Survey‐ascertained prevalence was highest in Wyoming (18.1), Utah (17.4), Iowa (15.3), Colorado (13.9), and Minnesota (12.1), and lowest in New Hampshire (1.2), Montana (1.5), Alaska (2.3), and Indiana (2.3). In Canada, survey‐ascertained prevalence was highest in Alberta (85.4) and Saskatchewan (65.3), and lowest in Quebec (2.9). Higher prevalence regions were geographically clustered in areas sharing dry or semi‐arid climates, higher elevation, higher temperature and lower humidity. PM2.5 modified the association between elevation and survey‐ascertained prevalence but was not independently associated with prevalence. Conclusions iSGS demonstrated geographic clustering in North America associated with higher altitude, lower humidity and higher temperatures; however, these ecological findings should be considered hypothesis‐generating and warrant further investigation using patient‐level exposure and biologic data. Level of Evidence This study represents Level 4 evidence given its ecological, cross‐sectional design.
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BibTeX
@article{harb2026geographic,
title = {{Geographic Clustering of Idiopathic Subglottic Stenosis in North America: An Ecological Cohort Study}},
author = {Ava S. Harb and Matthew Carson and Beau Ahrens and Fatemah Ramazani and Robbi A. Kupfer},
journal = {Laryngoscope investigative otolaryngology},
year = {2026},
month = oct,
doi = {10.1002/lio2.70607},
url = {https://europepmc.org/article/PMC/PMC13691189},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Geographic Clustering of Idiopathic Subglottic Stenosis in North America: An Ecological Cohort Study
AU - Ava S. Harb
AU - Matthew Carson
AU - Beau Ahrens
AU - Fatemah Ramazani
AU - Robbi A. Kupfer
PY - 2026
DA - 2026/10/01
JO - Laryngoscope investigative otolaryngology
DO - 10.1002/lio2.70607
UR - https://europepmc.org/article/PMC/PMC13691189
AB - Background Idiopathic subglottic stenosis (iSGS) is a recurrent fibroinflammatory narrowing of the subglottis, typically affecting White pre‐ and perimenopausal women. While its etiology remains uncertain, inflammatory signaling, reflux, hormonal influences, and mycobacterial factors have been proposed. This study evaluated geographic variability in survey‐ascertained iSGS prevalence, exploring potential environmental correlates associated with regional disease distribution. Methods A retrospective ecological analysis of self‐reported demographic and clinical data from members of an international iSGS online support group was performed. Responses were analyzed by continent, country, and US state or Canadian province. Estimated prevalence per 1,000,000 White females was calculated using census data and examined in relation to environmental and access‐related factors, including temperature, humidity, and particulate matter. Results Among 4450 survey respondents, 99.3% were female and 83.8% reported symptom onset after age 30. Survey‐ascertained prevalence was highest in Wyoming (18.1), Utah (17.4), Iowa (15.3), Colorado (13.9), and Minnesota (12.1), and lowest in New Hampshire (1.2), Montana (1.5), Alaska (2.3), and Indiana (2.3). In Canada, survey‐ascertained prevalence was highest in Alberta (85.4) and Saskatchewan (65.3), and lowest in Quebec (2.9). Higher prevalence regions were geographically clustered in areas sharing dry or semi‐arid climates, higher elevation, higher temperature and lower humidity. PM2.5 modified the association between elevation and survey‐ascertained prevalence but was not independently associated with prevalence. Conclusions iSGS demonstrated geographic clustering in North America associated with higher altitude, lower humidity and higher temperatures; however, these ecological findings should be considered hypothesis‐generating and warrant further investigation using patient‐level exposure and biologic data. Level of Evidence This study represents Level 4 evidence given its ecological, cross‐sectional design.
SN - 2378-8038
ER -