Characterization of Chronic Sinonasal Disease Symptoms in an Urban Homeless Population

Abstract

Background The urban homeless population has increased exposure to risk factors associated with chronic rhinosinusitis (CRS). However, a gap in knowledge of the prevalence of sinonasal symptoms in these demographic limits complete understanding of CRS epidemiology. There is a need to elucidate sinonasal disease burden in this vulnerable patient population to bring awareness to any existing disparities. Objective To assess the prevalence, severity, and associated factors of CRS clinical symptoms and health-care barriers in an urban homeless population. Methods Homeless adults completed a sociodemographic questionnaire and the 22-item Sinonasal Outcome Test (SNOT-22) and EuroQol-5 Dimension-3 Level-Visual Analog Scale surveys. Responses were categorized by potential CRS symptoms defined as reporting at least 2 CRS cardinal symptoms. Risk factors associated with potential CRS symptoms were analyzed with multivariate regression models. Results Fifty-six (16%) out of 341 total subjects reported potential CRS symptoms. Those with potential CRS symptoms had a higher median SNOT-22 score (53 vs 22, P < .001) than those without. Logistic regression models identified history of smoking (odds ratio [OR], 6.54; 95% confidence interval [CI], 2.04–21.04) and duration of homelessness over 3 months (OR, 3.46; CI, 1.51–7.94) as factors associated with potential CRS symptoms. Duration of homelessness over 3 months was associated with higher SNOT-22 scores (standardized beta coefficient [β], 0.48; CI, 0.39–0.57). Among those reporting 2 or more CRS cardinal symptoms, 18% had ever been seen by any physician for their symptoms. Conclusions Our study estimates a high prevalence of potential CRS symptoms in the urban homeless population. Longer duration of homelessness was associated with potential CRS symptoms and poor CRS-specific quality of life scores. Disparities in access to care emphasize the need for increased preventive efforts designed for this unique patient group.

The Impact of Social Determinants and Air Pollution on Healthcare Disparities in Chronic Rhinosinusitis With Nasal Polyps

“…6 Of those individuals with potential CRS, only 18% had ever been seen by a physician for their symptoms. 6 Studies of healthcare disparities in CRS have also demonstrated an association between non-white race and more severe CRS symptoms. Konsur et al published a large prospective cohort study assessing differential CRS outcomes based on race.…”

“…6 Of those individuals with potential CRS, only 18% had ever been seen by a physician for their symptoms. 6…”

Prevalence of Otolaryngology Diseases in an Urban Homeless Population

“…A few studies have focused on otolaryngology diseases in the homeless population 8–13 . Gurgel et al 12 evaluated otolaryngology needs in 11,690 homeless patients and found a prevalence of 15.2%; the most common diagnoses were upper respiratory infections, cough, dysphagia, and disorders of the ear.…”

“…6,7 A few studies have focused on otolaryngology diseases in the homeless population. [8][9][10][11][12][13] Gurgel et al 12 evaluated otolaryngology needs in 11,690 homeless patients and found a prevalence of 15.2%; the most common diagnoses were upper respiratory infections, cough, dysphagia, and disorders of the ear. Wu et al 8 examined 100 adult homeless individuals in Toronto, Canada, and identified 22 patients with otolaryngology needs, including 2 head and neck masses.…”

Staying Safe, Caring for Each Other, and Moving the Needle—Together

“…This current issue also contains several very unique articles which explore correlations in trends of sinusitisrelated online searches, 4 characterization of CRS in an urban homeless population, 6 an analysis of Eustachian tube dysfunction symptoms in CRS patients, 10 and a pilot study of a prospective needs assessment of mental health treatment options in patients with CRS. 11 Hahn et al 13 report their promising results on the clinical impact of maintenance therapy with daily acetylsalicylic acid on symptom control in patients with CRS with polyps (13).…”