Multicenter Study

. 2024 Nov;14(11):1700-1713.

doi: 10.1002/alr.23402. Epub 2024 Jul 5.

Impact of sociodemographic status and sex on chronic rhinosinusitis and olfaction in people with cystic fibrosis

Ethan J Han¹, Christine M Liu¹, Jakob L Fischer¹, Jess C Mace², Karolin Markarian³, Jeremiah A Alt⁴, Todd E Bodner⁵, Naweed I Chowdhury⁶, Patricia H Eshaghian⁷, Yuqing A Gao⁷, Anne E Getz⁸, Peter H Hwang⁹, Ashoke Khanwalkar⁸, Adam J Kimple¹⁰, Jivianne T Lee¹, Douglas A Li⁷, Meghan Norris¹⁰, Jayakar V Nayak⁹, Cameran Owens¹⁰, Zara M Patel⁹, Katie Poch¹¹, Rodney J Schlosser¹², Kristine A Smith⁴, Timothy L Smith², Zachary M Soler¹², Jeffrey D Suh¹, Grant A Turner⁷, Marilene B Wang¹, Jennifer L Taylor-Cousar^{11

13}, Milene T Saavedra¹¹, Daniel M Beswick¹

Affiliations

¹ Department of Head and Neck Surgery, University of California, Los Angeles, California, USA.
² Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA.
³ CTSI, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
⁴ Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA.
⁵ Department of Psychology, Portland State University, Portland, Oregon, USA.
⁶ Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁷ Department of Pulmonary Medicine, University of California, Los Angeles, California, USA.
⁸ Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Denver, Colorado, USA.
⁹ Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA.
¹¹ Department of Medicine, National Jewish Health, Denver, Colorado, USA.
¹² Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
¹³ Department of Pediatrics, National Jewish Health, Denver, Colorado, USA.

PMID: 38967583
PMCID: PMC11530317 (available on 2025-11-01)
DOI: 10.1002/alr.23402

Multicenter Study

Impact of sociodemographic status and sex on chronic rhinosinusitis and olfaction in people with cystic fibrosis

Ethan J Han et al. Int Forum Allergy Rhinol. 2024 Nov.

. 2024 Nov;14(11):1700-1713.

doi: 10.1002/alr.23402. Epub 2024 Jul 5.

Authors

Affiliations

¹ Department of Head and Neck Surgery, University of California, Los Angeles, California, USA.
² Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA.
³ CTSI, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
⁴ Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA.
⁵ Department of Psychology, Portland State University, Portland, Oregon, USA.
⁶ Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁷ Department of Pulmonary Medicine, University of California, Los Angeles, California, USA.
⁸ Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Denver, Colorado, USA.
⁹ Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA.
¹¹ Department of Medicine, National Jewish Health, Denver, Colorado, USA.
¹² Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
¹³ Department of Pediatrics, National Jewish Health, Denver, Colorado, USA.

PMID: 38967583
PMCID: PMC11530317 (available on 2025-11-01)
DOI: 10.1002/alr.23402

Abstract

Background: Sociodemographic status (SDS) including race/ethnicity and socioeconomic status as approximated by education, income, and insurance status impact pulmonary disease in people with cystic fibrosis (PwCF). The relationship between SDS and chronic rhinosinusitis (CRS) remains understudied.

Methods: In a prospective, multi-institutional study, adult PwCF completed the 22-Question SinoNasal Outcome Test (SNOT-22), Smell Identification Test (SIT), Questionnaire of Olfactory Disorder Negative Statements (QOD-NS), and Cystic Fibrosis Questionnaire-Revised (CFQ-R). Lund-Kennedy scores, sinus computed tomography, and clinical data were collected. Data were analyzed across race/ethnicity, sex, and socioeconomic factors using multivariate regression.

Results: Seventy-three PwCF participated with a mean age of 34.7 ± 10.9 years and 49 (67.1%) were female. Linear regression identified that elexacaftor/tezacaftor/ivacaftor (ETI) use (β = ‒4.09, 95% confidence interval [CI] [‒6.08, ‒2.11], p < 0.001), female sex (β = ‒2.14, 95% CI [‒4.11, ‒0.17], p = 0.034), and increasing age (β = ‒0.14, 95% CI [‒0.22, ‒0.05], p = 0.003) were associated with lower/better endoscopy scores. Private health insurance (β = 17.76, 95% CI [5.20, 30.32], p = 0.006) and >16 educational years (β = 13.50, 95% CI [2.21, 24.80], p = 0.020) were associated with higher baseline percent predicted forced expiratory volume in one second (ppFEV₁). Medicaid/Medicare insurance was associated with worse endoscopy scores, CFQ-R respiratory scores, and ppFEV₁ (all p < 0.017), and Hispanic/Latino ethnicity was associated with worse SNOT-22 scores (p = 0.047), prior to adjustment for other cofactors. No other SDS factors were associated with SNOT-22, QOD-NS, or SIT scores.

Conclusions: Differences in objective measures of CRS severity exist among PwCF related to sex, age, and ETI use. Variant status and race did not influence patient-reported CRS severity measures or olfaction in this study. Understanding how these factors impact response to treatment may improve care disparities among PwCF.

Clinical trials: NCT04469439.

Keywords: chronic rhinosinusitis; cystic fibrosis; patient symptoms; socioeconomic status.

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Conflict of interest statement

Conflict of Interest:

EJH: None to disclose.

CML: NIDCD grant related to work.

JLF: None to disclose

JCM: Has received grant support from CF Foundation related to this work in the past 36 months (BESWIC20AO)

JAA: Consultant for OptiNose and Medtronic. Speaker panel GSK. GlycoMira board and equity holder. Grant support from CF Foundation related to this work BESWIC20A0.

TEB: Has received grant support from CF Foundation related to this work in the past 36 months (BESWICZOAD)

NIC: Unrelated to this work, NIC has received grant support from the Burroughs Wellcome Fund, American Rhinologic Society, and the National Cancer Institute

AEG: None to disclose

PHH: Consultant for Stryker, Medtronic, Slate Therapeutics; Equity ownership in Sound Health Systems.

AK: Advisory Board for Sound Health Systems

AJK: Consultant for Acclarent.

JTL: None to disclose.

DAL: In the last 36 months, DAL has received grant support from the CF Foundation unrelated to this work.

MN: None to disclose.

JVN: Consultant with Aerin Medical; Equity/Patent with SpirAir LLC; Grant support from the National Institutes of Health (NIH). No COI related to this work

CO: None to disclose

ZMP: Consultant/Advisory Board for Optinose, Medtronic, Dianesis, Wyndly, Third Wave Therapeutics, Regeneron/Sanofi, Mediflix, ConsumerMedical. Equity in Olfera Therapeutics.

RJS: Consultant for OptiNose, Medtronic, Stryker, Cyrano. Medical Directory for Healthy Humming.

KAS: In the last 24 months, consultant for SanofiGenzyme

TLS: No disclosures.

ZMS: Consultant for OptiNose, Regeneron, SanofiGenzyme, and Lyra. Medical Directory for Healthy Humming.

GAT: In the last 36 months, GAT has received grants from the CF Foundation unrelated to this work.

MBW: None related to this work.

JLTC: In the last 36 months, JLT-C has received grants from the CF Foundation related to this work as well as for work unrelated to the manuscript. Unrelated to this work, she has received grants to her institution from Vertex Pharmaceuticals Incorporated, Eloxx, and 4DMT; has received fees to her institution from Vertex Pharmaceuticals Incorporated and 4DMT related to consultation on clinical research design. She served on a DMC for AbbVie. She serves as the adult patient care representative to the CFF Board of Trustees, and on the CF Foundation’s Clinical Research Executive Committee, Clinical Research Advisory Board, Racial Justice Working Group and as immediate past chair of the CF TDN’s Sexual Health, Reproduction and Gender Research Working Group, on the scientific advisory board for Emily’s Entourage, and as the ATS International Conference Committee Chair Elect. She previously served on the ATS Respiratory Health Awards, Scientific Grant Review and Clinical Problems Assembly Programming Committees.

MTS: MTS receives funding from CFF unrelated to this work.

DMB: In the last 36 months, DMB has received grant support from CF Foundation, International Society of Inflammation and Allergy of the Nose and the American Rhinologic Society CORE/Sue Ann and John L. Weinberg Foundation; honoraria from multiple sources including from National Jewish Health; consulting fees from Amgen, on medicolegal cases and from Garner Health (equity).

Remaining authors did not respond with any financial disclosures.

References

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Impact of sociodemographic status and sex on chronic rhinosinusitis and olfaction in people with cystic fibrosis

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Impact of sociodemographic status and sex on chronic rhinosinusitis and olfaction in people with cystic fibrosis

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