Health care disparities and chronic rhinosinusitis: Does neighborhood disadvantage impact outcomes in sinonasal disease?

Abstract

Objective: Socioeconomic status (SES) is linked to health outcomes but has not been well studied in patients with chronic rhinosinusitis (CRS). The area deprivation index (ADI) is a comprehensive measure of geographic SES that ranks neighborhood disadvantage. This investigation used ADI to understand the impact of neighborhood disadvantage on CRS treatment outcomes.

Methods: A total of 642 study participants with CRS were prospectively enrolled and self-selected endoscopic sinus surgery (ESS) or continued appropriate medical therapy as treatment. The 22-item SinoNasal Outcome Test (SNOT-22) and Medical Outcomes Study Questionnaire Short-Form 6-D (SF-6D) health utility value scores were recorded pre- and post-treatment. Using residence zip codes, national ADI scores were retrospectively assigned to patients. Spearman's correlation coefficients (Rs) and Cramer's V effect size (φ_c) with 95% confidence interval (CI) were calculated.

Results: A history of ESS was associated with significantly worse ADI scores compared to no history of ESS (φ_c = 0.18; 95% CI: 0.10, 0.25; p < 0.001). Baseline total SNOT-22 (Rs = 0.14; 95% CI: 0.06, 0.22; p < 0.001) and SF-6D values (Rs = -0.20; 95% CI: -0.27, -0.12; p < 0.001) were significantly negatively correlated with national ADI rank. No significant correlations between ADI and within-subject improvement, or achievement of >1 minimal clinically important difference, in SNOT-22 or SF-6D scores after treatment were found.

Conclusions: Geographic socioeconomic deprivation was associated with worse baseline disease severity and history of prior surgical intervention. However, ADI did not correlate with improvement in disease-specific outcomes. The impact of socioeconomic deprivation on outcomes in CRS requires further investigation.

Keywords: FESS; SNOT‐22; chronic rhinosinusitis; disease severity; quality of life.

Figure 1:

National Rank ADI total score distributions for the total cohort (n=642).

Figure 2:

Achievement of at least one minimum clinically important difference (MCID) in SNOT-22 by National Rank Area Deprivation Index (ADI). The proportions of subjects reporting improvement in SNOT-22 total scores were not statistically different between national ADI scoring quintiles (χ²=3.35; p=0.50).

Figure 3:

Achievement of at least one minimum clinically important difference (MCID) in SF-6D by National Rank Area Deprivation Index (ADI). The proportions of subjects reporting improvement in SF-6D health utility value scores were not statistically different between national ADI scoring quintiles (χ²=2.72; p=0.61).