Environmental air pollution and chronic rhinosinusitis: A systematic review

Leland, Evelyn M.; Vohra, Varun; Seal, Stella; Zhang, Zhenyu; Ramanathan, Murugappan

doi:10.1002/lio2.774

Cited by 23 publications

(25 citation statements)

References 62 publications

(99 reference statements)

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“…Clarhed et al found that occupational exposure to paper dust, cleaning agents, metal dust, animals, and moisture/moldy/mildew was independently related to having CRS ( 65 ). A recent review carried out by Leland et al found that air pollution (particularly PM) was closely correlated with CRS incidence/prevalence and disease severity ( 66 ). Additionally, Alkholaiwi et al highlighted that CRS symptoms' severity increased with direct contact with allergens, and the greatest proportion of patients with CRS was found among those with blue-collar occupations, such as firefighters, farmers, and fishermen ( 67 ).…”

Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors of chronic rhinosinusitis among Chinese: A systematic review and meta-analysis

Zhang

Zhang²,

Pang³

et al. 2023

Front. Public Health

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BackgroundChronic rhinosinusitis (CRS) can be seen in people of all ages. CRS heavily affects the quality of a patient's daily life and also causes tremendous economic burdens on patients' families and society. The prevalence of CRS in different countries varies and no systematic review of the prevalence of CRS among Chinese has been published previously. The objective of this systematic review and meta-analysis is to determine the prevalence of CRS among Chinese and to explore the main risk factors of CRS among Chinese.MethodsUsing relevant keywords, data resources including PubMed, Scopus, Web of Science, Google Scholar, Embase, Cochrane Library, Chinese National Knowledge of Infrastructure (CNKI), WANGFANG, VIP, and China Biomedical Literature database (CMB) were searched to obtain literature reporting the prevalence of and risk factors of CRS among Chinese which were clearly diagnosed with CRS from inception to 30 June 2022. The random/fixed effect model was used for meta-analysis, and the I2 index was employed to assess heterogeneity among studies. All analyses were performed by using the STATA version 16.0 software. The study was registered with PROSPERO, register number. CRD42022341877.ResultA total of 12 relevant kinds of literature were qualified for the present systematic review, including 4,033 patients. The results showed that the overall prevalence of CRS among Chinese was 10% (95%CI: 0.06–0.13, I2 = 99.6%, P < 0.001). The prevalence of CRS among Chinese who lived in urban cities was 18% (95%CI: −0.07 to 0.43, I2 = 99.9%, P < 0.001), which was obviously lower than the prevalence of CRS among Chinese who lived in rural areas (27%, 95%CI: −0.14 to 0.68, I2 = 99.8%, P < 0.001). The prevalence of CRS among Chinese before 2010 was 23% (95%CI: −0.05 to 0.50, I2 = 99.8%, P < 0.001), which was remarkably higher than the prevalence of CRS among Chinese after 2010 (7%, 95%CI: 0.05–0.09, I2 = 99.0%, P < 0.001). The prevalence of CRS among Chinese who were divorced was 17% (95%CI: 0.12–0.22, I2 = 0.0%, P = 0.436), while the prevalence of CRS among Chinese who were married, widowed, and unmarried was 9% (95%CI: 0.06–0.11, I2 = 88.1%, P = 0.004), 9% (95%CI: 0.06–0.11, I2 = 0.0%, P = 0.863), and 9% (95%CI: 0.08–0.10, I2 = 0.0%, P = 0.658), respectively. The prevalence of CRS among Han and minority Chinese was 8% (95%CI: 0.07–0.10, I2 = 69.6%, P = 0.070) and 12% (95%CI: 0.10–0.15, I2 = 38.6%, P = 0.202), respectively. The prevalence of CRS among Chinese who was never exposed to moldy or damp environments was 8% (95%CI: 0.08–0.09, I2 = 0.0%, P = 0.351), the prevalence of CRS among Chinese who was occasionally exposed to moldy or damp environments was 16% (95%CI: 0.10–0.22, I2 = 78.9%, P = 0.030), and the prevalence of CRS among Chinese who was frequently or every day exposed to moldy or damp environments was up to 20% (95%CI: 0.15–0.24, I2 = 0.0%, P = 0.558).ConclusionThis meta-analysis shows that the prevalence of CRS among Chinese is at a high level. People who have some risk factors, such as occasional or frequent or everyday exposure to moldy or damp environments, have a higher prevalence of CRS. We should attach more importance to the risk factors of CRS in clinical practice and disseminate scientific information and carry out education to lower the prevalence of CRS in China.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=341877, identifier: CRD42022341877.

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Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors of chronic rhinosinusitis among Chinese: A systematic review and meta-analysis

Zhang

Zhang²,

Pang³

et al. 2023

Front. Public Health

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“…Although exposure to environmental and occupational factors such as tobacco smoke, fire smoke and dust exposure have been linked with the prevalence of CRS, the association between the prevalence and severity of CRS and outdoor air pollution is far less understood [ 1 , 4 , 26 ]. According to a recent systematic review, 10 relevant manuscripts have been published before demonstrating higher odds of CRS particularly with PM exposure [ 27 ]. To our knowledge this is the first study using mixed models to describe symptom severity data of CRS patients in relation to outdoor air pollution exposure.…”

Section: Discussionmentioning

confidence: 99%

Association between outdoor air pollution and chronic rhinosinusitis patient reported outcomes

Peeters¹,

Wang

Bijnens

et al. 2022

Environ Health

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Background The aetiology of chronic rhinosinusitis (CRS) is multifactorial with a complex interplay between environmental, microbial endogenous and genetic factors. The impact of outdoor air pollution on prevalence or severity of CRS remains largely unknown. Methods Real-life geolocation data (2017–2018, Belgium) from 278 CRS patients (2576 health records) using the mySinusitisCoach mobile application were analysed to calculate the patients’ individual exposure to outdoor air pollutants (ozone (O3), black carbon (BC), nitrogen dioxide (NO2) and particulate matter with diameter < 2.5 μm (PM2.5)) and to associate these pollutants with the patients’ sinus related symptoms measured at multiple occasions by visual analogue scale (VAS). Results The adjusted seasonal model for the spring–summer (n = 1000 health entries, N = 83 patients) population revealed an increase of 6.07 (p < 0.0001) in overall CRS symptom scoring for an interquartile range (IQR) increase in exposure to O3 (26.9 μg/m3). An increase of 1.69 (p = 0.05) in total CRS symptom scoring was observed for an IQR increase of PM2.5 (7.1 µg/m3) exposure. Sex-stratified analysis in the spring–summer population showed significant interaction between air pollution and sex with male patients having higher total CRS symptom scores for an IQR increase in exposure to PM2.5 (3.52, p = 0.001), and O3 (8.33, p < 0.0001), while no significant association with symptom severity was seen in the female patients. In the analysis stratified by comorbid asthma, CRS patients with comorbid asthma had higher total CRS symptoms for an IQR increase in exposure to PM2.5 (2.58, p = 0.04) and O3 (7.72, p < 0.0001) while the patients without comorbid asthma had no significant symptom increases. Conclusion Exposure to outdoor air pollution is associated with increased symptom severity in CRS patients. The extent to which CRS patients are sensitive to outdoor air pollution exposure varies per season and depends on their sex and comorbid asthma status. mHealth technology has the potential to reveal novel insights on the patients’ exposome and disease severity in the real-life situation.

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“…31 A systematic review found that air pollutant exposure, specifically particulate matter and NO 2 , was associated with greater CRS incidence and prevalence, with higher air pollution exposure linked to more severe CRS. 2 Another study conducted in the active duty population found that particulate matter exposure was a major independent contributor to the development of CRS. 32 International studies have also demonstrated that exposure to high levels of air pollution is associated with significantly greater risk for the development of CRS.…”

Section: Air Pollution As a Factor In Healthcare Disparities In Crsmentioning

confidence: 99%

“…Although the exact pathophysiology is not fully understood, environmental pollutants have been shown to be associated with the development of CRS, likely through an increased inflammatory response in the nasal passages. 2,3 Globally, increasing air pollution levels have been linked to a variety of respiratory conditions, including allergic rhinitis, asthma, and CRS. Studies have shown an increased incidence of CRS in areas with higher traffic-related air pollution, which may also be areas with residents of lower SES.…”

Section: Introductionmentioning

confidence: 99%

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

Peterson

Keswani

2023

Am J Rhinol�Allergy

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Background/Objective Multiple factors affect healthcare disparities in chronic rhinosinusitis (CRS) with and without nasal polyps. These factors include access to care, economic burdens to treatment, and differences in air pollution and air quality. In this paper, we will discuss how socioeconomic status, race, and air pollution burden influence healthcare disparities in the diagnosis and treatment outcomes of chronic rhinosinusitis with nasal polyps (CRSwNP). Methods A literature search was performed via PubMed for articles related to CRSwNP, healthcare disparities, race, socioeconomic status, and air pollution in September 2022. Original studies from 2016 to 2022, landmark articles, and systematic reviews were included. We summarized these articles to cohesively discuss factors contributing to healthcare disparities in CRSwNP. Results Literary search produced 35 articles. Individual factors such as socioeconomic status, race, and air pollution influence CRSwNP severity and treatment outcomes. Correlations were noted with socioeconomic status, race, and air pollution exposure and CRS severity and post-surgical outcomes. Air pollution exposure was also associated with histopathologic changes in CRSwNP. Lack of access to care was a notable contributor to healthcare disparities in CRS. Conclusion Healthcare disparities in the diagnosis and treatment of CRSwNP differentially affect racial minorities and individuals of lower socioeconomic status. Increased air pollution exposure in areas of lower socioeconomic status is a compounding factor. Clinician advocacy for greater healthcare access and reductions in environmental exposures for patients, among other societal changes, may help improve disparities.

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Environmental air pollution and chronic rhinosinusitis: A systematic review

Cited by 23 publications

References 62 publications

Prevalence and risk factors of chronic rhinosinusitis among Chinese: A systematic review and meta-analysis

Prevalence and risk factors of chronic rhinosinusitis among Chinese: A systematic review and meta-analysis

Association between outdoor air pollution and chronic rhinosinusitis patient reported outcomes

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

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