Samuelson Madeleine B, Chandra Rakesh K, Turner Justin H, Russell Paul T, Francis David O
Division of Rhinology, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Am J Rhinol Allergy. 2017 Nov 1;31(6):376-381. doi: 10.2500/ajra.2017.31.4476.
Chronic rhinosinusitis (CRS) has a high prevalence and significant cost and quality of life implications. Many types of practitioners care for patients with rhinosinusitis; however, patients with chronic or complicated conditions are often referred for tertiary rhinology services. It is unclear how social determinants of health affect access and utilization of these services. A better understanding of social barriers to tertiary rhinology care is needed to reduce health care disparities and improve health outcomes. The aim of the present study was to measure whether income, insurance status, race, and education affect utilization of tertiary rhinology care.
All adult patients diagnosed with CRS by rhinologists at a single tertiary care hospital were identified (2010-2014). Patient characteristics (age, gender, race, insurance status) were compared with population-level data from the hospital and from Davidson County, Tennessee, which includes Nashville. Rhinology utilization rates were calculated for each ZIP code within the county. The association between determinants of health (race, insurance status, education, median income) and tertiary rhinology utilization were measured by using multivariable regression analyses.
A total of 1341 unique patients with CRS (median age, 50 years; 55% women, 80% white, 82% with private insurance) from Davidson County used tertiary rhinology services. These patients were significantly older and more likely to be female, white, and privately insured than patients seen hospital-wide or among the population of Davidson County (p < 0.001). Utilization rates were higher in ZIP codes with a lower proportion of minorities, a higher median income, and higher rates of private insurance and college education. However, in adjusted analysis, only attainment of a college education was independently associated with utilization of tertiary rhinology services. Utilization was 4% higher for every 1% increase in college-educated population (coefficient 0.04 [95% CI, 0.01-0.07]; p = 0.01).
Results of this study indicated that some social determinants of health (race, income, educational level, insurance status) do affect utilization of tertiary rhinology services. Higher utilization among those with higher income and educational attainment are contradictory to the data, which indicated that lower socioeconomic status was associated with a higher CRS rate. Further study is required to understand the disparities in rhinology utilization rates.
慢性鼻-鼻窦炎（CRS）患病率高，成本高昂，对生活质量有重大影响。许多类型的从业者都为鼻-鼻窦炎患者提供护理；然而，患有慢性或复杂病症的患者通常会被转诊至三级鼻科服务机构。尚不清楚健康的社会决定因素如何影响这些服务的可及性和利用情况。为了减少医疗保健差距并改善健康结果，需要更好地了解三级鼻科护理的社会障碍。本研究的目的是衡量收入、保险状况、种族和教育程度是否会影响三级鼻科护理的利用情况。
确定了一家三级医疗医院的鼻科医生诊断出的所有成年CRS患者（2010 - 2014年）。将患者特征（年龄、性别、种族、保险状况）与该医院以及田纳西州戴维森县（包括纳什维尔）的人群水平数据进行比较。计算该县内每个邮政编码区域的鼻科利用率。通过多变量回归分析衡量健康决定因素（种族、保险状况、教育程度、收入中位数）与三级鼻科利用之间的关联。
来自戴维森县的总共1341例独特的CRS患者（年龄中位数为50岁；55%为女性，80%为白人，82%拥有私人保险）使用了三级鼻科服务。与全院就诊患者或戴维森县人群相比，这些患者年龄明显更大，更有可能是女性、白人且拥有私人保险（p < 0.001）。在少数族裔比例较低、收入中位数较高、私人保险率和大学教育率较高的邮政编码区域，利用率更高。然而，在调整分析中，只有大学教育程度与三级鼻科服务的利用独立相关。大学学历人口每增加1%，利用率就会提高4%（系数0.04 [95% CI，0.01 - 0.07]；p = 0.01）。
本研究结果表明，一些健康的社会决定因素（种族、收入、教育水平、保险状况）确实会影响三级鼻科服务的利用情况。收入和教育程度较高者利用率较高，这与表明社会经济地位较低与CRS发病率较高相关的数据相矛盾。需要进一步研究以了解鼻科利用率的差异。
