种族和保险状况对慢性鼻-鼻窦炎患者基线组织病理学特征的影响。
The impact of race and insurance status on baseline histopathology profile in patients with chronic rhinosinusitis.
机构信息
Rush Medical College - Rush University Medical Center, Chicago, IL, 60612.
Department of Otorhinolaryngology - Head and Neck Surgery, Rush Sinus Program, Rush University Medical Center, Chicago, IL, 60612.
出版信息
Int Forum Allergy Rhinol. 2019 Jun;9(6):665-673. doi: 10.1002/alr.22295. Epub 2019 Feb 12.
BACKGROUND
Chronic rhinosinusitis (CRS) is an inflammatory disease process characterized by different phenotypes and histopathology profiles. Race and access to care have been implicated in CRS disease severity. Structural histopathology reporting may aid in delineating the inflammatory burden responsible for this effect.
METHODS
A structured histopathology report of 14 variables was utilized to assess sinus tissue removed during functional endoscopic sinus surgery (FESS). Histopathology variables and 22-item Sino-Nasal Outcome Test (SNOT-22) scores were compared by race (Black, White, Latino, and Asian) and insurance status (Medicare, Medicaid, and private insurance).
RESULTS
A total of 201 CRS patients (124 White, 38 Black, 28 Latino, and 9 Asian) undergoing FESS were included. Black patients demonstrated increased SNOT-22 scores (50.74 ± 20.32 vs 41.47 ± 22.75, p < 0.022) and number of eosinophils per high-power field (>5/HPF) (60.5% vs 44.8%, p < 0.05). White patients demonstrated decreased eosinophil aggregates (22.6% vs 35.1%, p < 0.039) and eosinophils/HPF (<5/HPF) (42.7% vs 55.8%, p < 0.048). Medicaid patients showed increased SNOT-22 score (55.50 ± 24.46 vs 41.39 ± 21.74, p < 0.003), polypoid disease (61.5% vs 42.3%, p < 0.05), subepithelial edema (80.8% vs 53.1%, p < 0.006), hyperplastic/papillary changes (23.1% vs 8.0%, p < 0.028), fibrosis (61.5% vs 38.5%, p < 0.036), eosinophil aggregates (46.2% vs 24.6%, p < 0.022), and eosinophils/HPF (>5/HPF) (65.4% vs 45.1%, p < 0.043). When controlling for insurance status, Black race was no longer associated with increased SNOT-22 (p < 0.104) or eosinophils/HPF (>5/HPF) (p < 0.183).
CONCLUSION
Black and Medicaid patients demonstrated more severe disease by histopathology and SNOT-22 scores. These findings were no longer significant among Black patients after adjusting for insurance status, suggesting that the prevailing factor influencing worse disease may be access to care.
背景
慢性鼻-鼻窦炎（CRS）是一种以不同表型和组织病理学特征为特征的炎症性疾病过程。种族和获得医疗保健的机会与 CRS 疾病的严重程度有关。结构性组织病理学报告可能有助于确定导致这种影响的炎症负担。
方法
利用 14 项变量的结构化组织病理学报告来评估在功能性内窥镜鼻窦手术（FESS）期间切除的鼻窦组织。根据种族（黑种人、白种人、拉丁裔和亚洲人）和保险状况（医疗保险、医疗补助和私人保险）比较组织病理学变量和 22 项鼻-鼻窦结局测试（SNOT-22）评分。
结果
共纳入 201 例接受 FESS 的 CRS 患者（白种人 124 例，黑种人 38 例，拉丁裔 28 例，亚洲人 9 例）。黑种人患者的 SNOT-22 评分（50.74±20.32 与 41.47±22.75，p<0.022）和高倍镜视野下的嗜酸性粒细胞数（>5/HPF）（60.5%与 44.8%，p<0.05）更高。白种人患者的嗜酸性粒细胞聚集物（22.6%与 35.1%，p<0.039）和嗜酸性粒细胞/HPF（<5/HPF）（42.7%与 55.8%，p<0.048）减少。医疗补助患者的 SNOT-22 评分（55.50±24.46 与 41.39±21.74，p<0.003）、息肉样病变（61.5%与 42.3%，p<0.05）、上皮下水肿（80.8%与 53.1%，p<0.006）、增生/乳头状改变（23.1%与 8.0%，p<0.028）、纤维化（61.5%与 38.5%，p<0.036）、嗜酸性粒细胞聚集物（46.2%与 24.6%，p<0.022）和嗜酸性粒细胞/HPF（>5/HPF）（65.4%与 45.1%，p<0.043）更高。在控制保险状况后，黑种人的种族与 SNOT-22（p<0.104）或嗜酸性粒细胞/HPF（>5/HPF）（p<0.183）增加不再相关。
结论
黑人和医疗补助患者的组织病理学和 SNOT-22 评分显示疾病更严重。在调整保险状况后，黑种人患者的这些发现不再显著，这表明影响疾病更严重的主要因素可能是获得医疗保健的机会。
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