A retrospective, cross-sectional study reveals that women with CRSwNP have more severe disease than men

Abstract

Up to 50% of patients with chronic rhinosinusitis (CRS) have comorbid asthma, and we have reported that a subset of CRS patients who have nasal polyps (CRSwNP) have elevated autoantigen-specific antibodies within their nasal polyps (NP). While increases in the prevalence and/or severity of both asthma and autoimmunity in women are well characterized, it is not known whether CRSwNP is more severe or frequent in women than men. We sought to determine whether CRSwNP demonstrated sex-specific differences in frequency and/or severity. Using a retrospectively collected database of tertiary care patients (n = 1393), we evaluated the distribution of sex in patients with CRSwNP with or without comorbid asthma or aspirin hypersensitivity. We further compared the severity of sinus disease between men and women with CRSwNP. Although women comprised 55% of CRS patients without NP (CRSsNP), a significantly smaller proportion of CRSwNP patients were female (38%, P < 0.001). Interestingly, women with CRSwNP were significantly more likely than men to have comorbid asthma (P < 0.001), and 61% of patients with the most severe form of disease (aspirin-exacerbated respiratory disease (CRSwNP plus asthma plus aspirin sensitivity)) were women (P < 0.05). Women with CRSwNP were significantly more likely to have taken oral steroids, and were more likely to have a history of revision surgeries (P < 0.05) compared to men. These data suggest that women with CRSwNP have more severe disease than men in a tertiary care setting. Future studies are needed to elucidate the mechanisms that drive disease severity in men and women, paving the way for the development of personalized treatment strategies for CRSwNP based on sex.

Keywords: AERD; asthma; chronic inflammation; chronic rhinosinusitis; oral steroids.

Figure 1

Proportion of patients that were women in each group. The frequency of women was determined among all patients recruited for study on CRS at Northwestern University between 2003–2013 (n = 1393). (A). The proportion of women was not different between control and CRSsNP patients. However, women were much less likely than men to have CRSwNP compared to CRSsNP and AERD patients. (B). Among all patients with CRSwNP, women were 2.5 times more likely to have AERD. *P < 0.05, **P < 0.01, ***P < 0.001 by Chi-squared test.

Figure 2

Frequency of asthma and atopy among men and women. (A). CRSwNP women were more likely to have comorbid asthma (64%) compared to CRSwNP men (46%). Asthma frequency was not different between men and women in the control or CRSsNP groups. (B). There was no difference in the frequency of atopy between men and women in any group. ***P < 0.001 by Chi-squared test.

Figure 3

Race and oral steroid use in men and women with CRSwNP. (A). Women with CRSwNP were more likely to be African-American compared to men (18% vs. 10%). (B). Women with CRSwNP were more likely to be prescribed perioperative oral steroids than men (29% vs. 20%). (C). Women with CRSwNP with asthma had the highest frequency of oral steroid use (39%). *P < 0.05, ***P < 0.001 by Chi-squared test.

Figure 4

Sinus disease severity in men and women with CRSwNP. (A). There was no difference in the Lund–Mackay scores for men and women with CRSwNP. Boxes represent medians with 25th and 75th percentiles, whiskers represent the min and max values. (B). Women with CRSwNP were two times more likely to be diagnosed with severe sinus disease, compared to men (36% vs. 17%). **P < 0.01 by Chi-squared test.

Figure 5

Revision surgeries in men and women with CRSwNP. (A). CRSwNP women were more likely to require revision surgery than men (42% vs. 29%). (B). Women with CRSwNP required more surgeries on average than men. Line represents the mean. (C). CRSwNP women with asthma had the highest frequency of revision surgeries (50%). *P < 0.05 by Chi-squared test (A and C) or by Mann–Whitney U test (B).