Association of Socioeconomic Status, Race and Insurance Status with Chronic Rhinosinusitis Patient‐Reported Outcome Measures

Abstract

Objective Disparities in health and health care access are widely prevalent. However, disparities among patients with chronic rhinosinusitis (CRS) are poorly understood. We investigated if CRS severity at presentation according to socioeconomic factors. Study Design Cross-sectional study. Setting Tertiary rhinology center. Subjects and Methods Three hundred prospectively recruited patients presenting with CRS were included. Outcome variables included CRS symptomatology, as reflected by the 22-item Sinonasal Outcome Test (SNOT-22); general health status, as reflected by the EuroQol 5-dimensional visual analog scale (EQ-5D VAS); and CRS-related antibiotic and systemic corticosteroid use. Race/ethnicity, zip code income bracket, education level, and insurance status were used as predictor variables. Regression, controlling for clinical and demographic characteristics, was used to determine associations between predictor and outcome variables. Results Mean SNOT-22 score was 33.8 (SD, 23.2), and mean EQ-5D VAS score was 74.2 (SD, 18.9). On multivariable analysis, presenting SNOT-22 and EQ-5D VAS scores were not associated with nonwhite patient race/ethnicity ( P = .634 and P = .866), education ( P = .106 and P = .586), or the percentage of households in zip code with incomes <$50,000 per year ( P = .917 and P = .979, respectively). SNOT-22 scores did not differ by insurance type, but patients receiving Medicare reported worse general health status. Use of oral antibiotics or oral steroids for CRS was not associated with predictor variables. Conclusion Patients with CRS presented to a tertiary rhinology center with similar metrics for CRS severity and pre-presentation medical management regardless of race/ethnicity, education status, or zip code income level. Patients with Medicare had worse general health status. Further research should investigate potential disparities in diagnosis of CRS, specialist referral, and treatment outcomes.

Socioeconomic factors impact quality of life outcomes and olfactory measures in chronic rhinosinusitis

“…Our results showed that male gender and higher mean age were associated with lower (better) preoperative SNOT‐22 total scores. Even though the current study population and the population evaluated by Bergmark et al . are lacking some generalizability due to baseline QOL status and differences in treatment modality, our preoperative findings (Table ) are similar to those of Bergmark et al., who found no significant associations between race/ethnicity, zip code–based income, education level, or insurance status and mean baseline SNOT‐22 score or the EuroQol 5‐dimensional visual analogue scale, among patients with CRS presenting to a tertiary care center.…”

“…Even though the current study population and the population evaluated by Bergmark et al . are lacking some generalizability due to baseline QOL status and differences in treatment modality, our preoperative findings (Table ) are similar to those of Bergmark et al., who found no significant associations between race/ethnicity, zip code–based income, education level, or insurance status and mean baseline SNOT‐22 score or the EuroQol 5‐dimensional visual analogue scale, among patients with CRS presenting to a tertiary care center. Additionally, the finding in the current study that male subjects reported lower (better) preoperative SNOT‐22 scores compared to female patients is consistent with prior work …”

“…Studies have demonstrated that utilization of rhinology healthcare services, as well as the prevalence and severity of CRS, are affected by various socioeconomic factors . On the other hand, alternative investigations have shown that baseline CRS disease severity is similar across different measures of SES, such that there are no differences in SES between patients with CRS and controls without sinus disease, and that outcomes following endoscopic sinus surgery (ESS) were not influenced by certain socioeconomic factors . No studies have thoroughly assessed the impact of SES on olfactory status among patients with CRS.…”

Intranasal corticosteroids and saline: Usage and adherence in chronic rhinosinusitis patients

“…Factors related to the medications, such as the complexity of the regimen, its side effects, or its costs, are also associated with adherence, which is consistent with the suggestion of our results that the use of intranasal corticosteroid sprays over irrigations may be associated with greater adherence. Other social factors, such as healthcare access, socioeconomic factors, and patient education, have also been described, although we did not study these characteristics because we previously found our patients to be quite homogeneous with respect to these characteristics . However, it is very likely that social factors may also have an impact on adherence with CRS medications …”

“…Other social factors, such as healthcare access, socioeconomic factors, and patient education, have also been described, although we did not study these characteristics because we previously found our patients to be quite homogeneous with respect to these characteristics. 23 However, it is very likely that social factors may also have an impact on adherence with CRS medications. 10,24 This study should be interpreted in the context of its limitations.…”