Author(s)
Bita Naimi, BA
Emily Garvey, BA
Alexander Duffy, MD
Zachary Urdang, PhD, MD
Douglas Farquhar, MD
Marc Rosen, MD, FARS
Gurston Nyquist, MD, FARS
Elina Toskala, MD, PhD, FARS
Mindy Rabinowitz, MD, FARS
Affiliation(s)
Thomas Jefferson University;
Abstract:
Introduction:
This study used a national database to explore associations of unfavorable social determinants of health (SDOH) with chronic rhinosinusitis (CRS) treatment and complications.
Method: S
The TriNetX database United States network was queried by ICD-10 codes to identify unfavorable SDOH, CRS-specific treatments, and CRS-related complications. Patients with a previous history of any queried complication or treatment (not including antibiotics) prior to CRS diagnosis were excluded from the analysis.
Results:
2,179,417 US adults were diagnosed with CRS from 2015 to 2022, among which 23,335 (1.07%) experienced unfavorable SDOH including job insecurity, housing insecurity, and low education level. Within one year after CRS diagnosis, those with unfavorable SDOH were more likely to be prescribed CRS-related antibiotics (1.61, 1.57-1.66), saline irrigation (1.45, 1.28-1.64), and intranasal steroid spray (1.46, 1.30-1.64). There was no statistical difference in oral prednisone or methylprednisolone treatment within a year of CRS diagnosis. Those with unfavorable SDOH had all-time lower odds of endoscopic sinus surgery (0.88, 0.81-0.95). Patients with unfavorable SDOH had higher odds of complications within 6 months of CRS diagnosis, including bacterial meningitis (3.41, 1.99-5.84) and brain abscess (3.58, 2.41-5.31).
Conclusion:
Patients with unfavorable SDOH are more likely to be treated medically and less likely surgically for CRS, with increased odds of severe CRS-related complications. Providers should identify these patients and consider frequent follow-up and referral to social work for support. As a database study,
Results: are limited by the fact that treatments or complications may not always be directly due to CRS.