Author(s)
Emily Garvey, BA
Bita Naimi, BA
Alexander Duffy, MD
Zachary Urdang, PhD, MD
Marc Rosen, MD, FARS
Gurston Nyquist, MD, FARS
Elina Toskala, MD, PhD, FARS
Mindy Rabinowitz, MD, FARS
Affiliation(s)
Abstract:
Introduction: Chronic Rhinosinusitis may be divided into Chronic Sinusitis with (CRSwNP) and without nasal polyps (CRSsNP). Although expensive, biologics have emerged as a treatment option for patients with refractory CRSwNP. No studies have explored demographic differences in access to biologic therapies for patients with CRSwNP.
Methods: The TriNetX United States Collaborative Network was queried for patients with CRSsNP and CRSwNP using ICD-10 codes. Cohorts were created based on ethnicity and race. Outcomes included biologic prescription, endoscopic sinus surgery (ESS), oral antibiotic, and steroid use. Propensity score matching created balanced cohorts.
Results: 1,662,914 Non-Hispanic Caucasian, 283,794 Black, and 127,276 Hispanic CRS patients were identified. Of these patients, 5.7% Caucasian, 6.2% Black, and 5.5% of Hispanic patients had CRSwNP. Black patients had higher rates of all comorbidities examined including asthma and dermatitis (p<0.0001). After propensity score matching, Black individuals had the highest rates of dupilumab use compared to Caucasian (OR: 1.28, p<0.0001) and Hispanic populations (OR: 2.00 p<0.0001). Black individuals were also more likely to have ESS than their Caucasian counterparts (OR: 1.16, p<0.0001).
Conclusions: Black patients were more likely to be prescribed biologics for CRS compared to their Hispanic and Caucasian counterparts. They were also more likely to undergo ESS, this may be related more severe disease. Despite the cost, biologic therapy represents a viable treatment for severe disease cross demographics. Understanding access to CRS treatment and disease severity across populations is important to promote health equity.