Racial and Ethnic Disparities in Dysphagia Care Access, Utilization, and Quality in the United States: A Scoping Review.

Racial and ethnic disparities in healthcare access, utilization, and quality are well-documented, but have been largely unexplored for individuals with oropharyngeal dysphagia. We conducted a scoping review to (1) describe methods used to assess disparities in oropharyngeal dysphagia care, (2) summarize study findings, and (3) make recommendations for future research based on literature gaps. We searched MEDLINE (Ovid), Embase, APA PsycInfo, and CINAHL (January 1990-December 2024) for original experimental or observational studies evaluating associations between race and/or ethnicity and access to, utilization, or quality of oropharyngeal dysphagia care. Two reviewers completed title/abstract screening and full-text review. We extracted study metadata, methods, and results and synthesized findings quantitatively and narratively. We retrieved 3,201 records; after deduplication, 2,498 underwent title/abstract screening, 61 full-text review, and 9 were included. Studies varied substantially in definitions of dysphagia care, operationalization of race/ethnicity, data sources, and analytic approaches. Importantly, no studies examined disparities in access to care or quality of care. A key methodological finding was that results differed systematically by whether analyses accounted for clinical need: analyses controlling for proxies of need more often found lower utilization among Black patients (or no differences), whereas analyses without need adjustment more often reported similar or higher utilization among racially and ethnically minoritized groups. These findings underscore the need for more methodologically rigorous research on disparities across the dysphagia care continuum. We propose a framework to guide future studies and recommendations to improve measurement of care, race/ethnicity, and clinical need.