Department of Otolaryngology, University of Colorado, Aurora, CO.
Division of Rhinology and Sinus/Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, OR.
Int Forum Allergy Rhinol. 2019 Sep;9(9):1000-1009. doi: 10.1002/alr.22374. Epub 2019 Jun 27.
Social determinants of health can have a substantial impact on treatment outcomes. Prior study has shown that socioeconomic status influences the likelihood of improvement in quality-of-life (QOL) following endoscopic sinus surgery (ESS). However, the impact of socioeconomic factors on changes in productivity loss and health utility after ESS remains unknown.
Adult patients (≥18 years of age) with chronic rhinosinusitis (CRS) who underwent ESS were prospectively enrolled into a multi-institutional cohort study. Productivity losses were calculated using the human capital approach and monetized using U.S. government-estimated wage rates. Health utility values (HUVs) were derived from the Medical Outcomes Study Short-Form-12 survey using University of Sheffield algorithms. Independent socioeconomic factors of interest included: age, gender, ethnicity, insurance status, educational attainment, and household income categorized via the Thompson-Hickey model.
A total of 229 patients met inclusion criteria, and 163 (71%) provided postoperative follow-up. All subjects reported significant, within-subject improvement in both mean monetized productivity loss (p < 0.001) and HUV postoperatively (p < 0.001). Using paired sample statistics, patients with lowest income (≤$25,000/year) and with Medicare insurance did not report significant improvement in productivity loss (p ≥ 0.112) or HUV (p ≥ 0.081), although sample size limitations may have contributed to this finding. Patients in higher income tiers ($25,001 to $100,000/year and $100,001+/year) and those with employer-provided/private health insurance reported significant postoperative improvements in productivity loss and HUV (all p ≤ 0.003).
Socioeconomic factors, including income and insurance provision, may impact improvements in productivity loss and HUV following ESS. Further research to validate these findings, ascertain mechanisms behind these results, and improve these outcomes is warranted.
健康的社会决定因素会对治疗结果产生重大影响。先前的研究表明，社会经济地位会影响内镜鼻窦手术（ESS）后生活质量（QOL）改善的可能性。然而，社会经济因素对 ESS 后生产力损失和健康效用变化的影响尚不清楚。
接受 ESS 的慢性鼻-鼻窦炎（CRS）成年患者（≥18 岁）前瞻性纳入多机构队列研究。使用人力资本方法计算生产力损失，并使用美国政府估计的工资率进行货币化。健康效用值（HUV）通过使用谢菲尔德大学算法的医疗结局研究简明健康调查问卷得出。感兴趣的独立社会经济因素包括：年龄、性别、种族、保险状况、教育程度和家庭收入，通过汤普森-希基模型进行分类。
共有 229 名患者符合纳入标准，其中 163 名（71%）提供了术后随访。所有患者报告称，术后平均货币化生产力损失（p<0.001）和 HUV 均有显著的个体内改善（p<0.001）。使用配对样本统计，收入最低（≤25000 美元/年）和拥有医疗保险的患者在生产力损失（p≥0.112）或 HUV（p≥0.081）方面没有报告显著改善，尽管样本量限制可能导致了这一发现。收入较高的患者（25001 美元至 100000 美元/年和 100001 美元/年及以上）和拥有雇主提供/私人医疗保险的患者在生产力损失和 HUV 方面均报告了显著的术后改善（所有 p 值均≤0.003）。
社会经济因素，包括收入和保险提供情况，可能会影响 ESS 后生产力损失和 HUV 的改善。需要进一步研究来验证这些发现，确定这些结果背后的机制，并改善这些结果。
