2018 Section 5 - Rhinology and Allergic Disorders

Otolaryngology–Head and Neck Surgery 153(1)

Table 1. Differences in Demographic and County Characteristics between AFRS, CRSwNP, and CRSsNP Patients.

Demographic and County Characteristics

AFRS (n = 93)

CRS (n = 93)

CRSsNP (n = 32)

CRSwNP (n = 61)

P Value

\ .0001

Age at diagnosis, y, mean (SD)

29 (15)

44 (12)

44 (11)

44 (13)

Gender, n (%)

.116

Male

53 (58) 39 (42)

48 (52) 45 (48)

12 (38) 20 (62)

36 (59) 25 (41)

Female

\ .0001

Race, n (%)

White

37 (41) 54 (59)

77 (85) 14 (15)

26 (84)

51 (85)

African American

5 (16)

9 (15)

Payment method, n (%)

.07

Self-pay/Medicaid subsidized

29 (32)

18 (21) 10 (11)

4 (13) 5 (17) 3 (10)

14 (24)

Medicare

2 (2)

5 (9) 4 (7)

Military Private

10 (11) 51 (55)

7 (8)

53 (60)

18 (60)

35 (60)

HSA geographical area, n (%)

.2

1 2 3 4 5 6

1 (1) 7 (7) 4 (4)

0 (0) 7 (8) 2 (2)

0 (0) 2 (7) 1 (3)

0 (0) 5 (9) 1 (2)

34 (37) 31 (34) 15 (16)

51 (58) 21 (24)

18 (60)

33 (57) 16 (28)

5 (17) 4 (13)

7 (8)

3 (5)

Income per capita, US dollars, mean (SD)

25,168 (5203)

27,588 (5405)

27,457 (6014)

27,655 (5116)

.01 .09

Primary care physician, n (%)

0.1 (0.07)

0.13 (0.09)

0.13 (0.1)

0.12 (0.09)

Overcrowded housing residents, n (%)

2 (0)

2 (0.1)

2 (0)

2 (0)

.2 .8 .2

Residents in . 30 year old housing units, n (%)

12 (3)

12 (3)

12 (3)

12 (3)

Rural population, n (%)

32 (24)

30 (27)

29 (26)

31 (28)

Abbreviations: AFRS, allergic fungal rhinosinusitis; CRS, chronic rhinosinusitis; CRSsNP, CRS without nasal polyps; CRSwNP, CRS with nasal polyps; HSA, Health Services Area.

Associations between Demographic and County- Specific Characteristics and Markers of Disease Severity for CRS Patients Within the CRS patient cohort, no significant associations were found for each indicator of disease severity and patient demographic and county-specific characteristic. No other associations were clinically relevant. Discussion Determinants of health outcomes can be categorized into 5 domains: genetics, environmental exposure, social circum- stances, behavioral patterns, and health care. 19 In terms of proportional contribution to premature death and determina- tion of health in the United States, care received at a health facility accounts for about only 10%, while genetic disposi- tion accounts for 30%, social circumstances 15%, environ- mental exposure 5%, and behavioral patterns 40%. 19 Therefore, it is of paramount importance to investigate demographic and socioeconomic determinants of disease severity for patients with CRS (including AFRS), a chronic disease accounting for a substantial portion of physician visits and health care cost. 10 Demographic differences found between the AFRS and CRS patients in our study suggest that AFRS patients are younger at

diagnosis. This is consistent with a retrospective review study by Wise et al, 13 who found the average age of CRSwNP, CRSsNP, and AFRS at diagnosis was 48, 43, and 28 years, respectively. CRS has been found to be most prevalent between the ages of 40 and 63 years, 20 while AFRS generally presents at a younger age, between 21 and 33 years, suggesting different patient populations between the 2 conditions. 12-14,21-23 Racial and ethnic differences between the 3 subgroups in our study suggest that a larger proportion of AFRS patients are African Americans, a pattern found in other studies. 12-14,17,19,22 In addi- tion, CRS patients were less likely to be self-pay or have subsi- dized insurance coverage and were more likely to live in regions with higher income and better access to primary care providers compared with AFRS patients. To characterize and compare disease severity of CRS patients, several markers of hypersensitivity were studied. 24,25 CRS patients had overall lower markers of a hypersensitivity component of their disease severity compared with AFRS coun- terparts, consistent with a previous study that demonstrated clear immunologic differences. 26 The immunopathologic role of allergy in CRS is controversial. While type 1 sensitivity has been proposed as a contributing factor in CRSwNP, CRSsNP, and all cases of AFRS (which includes type 1 sensitivity as a diagnostic criteria), evidence from various studies has shown conflicting results in terms of prevalence of allergy and its

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