14681Department of Otolaryngology, Head and Neck Surgery, University of Illinois Chicago, Chicago, IL, USA.
Division of Health Policy and Administration, School of Public Health, 14681University of Illinois Chicago, Chicago, IL, USA.
Am J Rhinol Allergy. 2022 Nov;36(6):884-889. doi: 10.1177/19458924221112130. Epub 2022 Jul 15.
Social determinants of health (SDOH) and comorbid conditions (CMCs) influence the setting of presentation for care; however, few studies have explored this relationship in the context of sinus disease.
This study aims to characterize the relationship of SDOH and CMCs with acuity of health care presentation setting in adults with sinusitis.
A retrospective analysis based on medical records (demographics, visit types, and ICD-10 codes) of 1842 adult patients presenting with sinusitis to an urban academic medical center was conducted. Chi-square analysis was used to assess bivariate associations of SDOH (age, race/ethnicity, sex, insurance type, and employment status) and CMCs (depression, body mass index [BMI], allergy, and gastroesophageal reflux disease [GERD]) with high-acuity visit types-including emergency department (ED) and inpatient visits. Multivariable binary logistic regression was performed to examine the adjusted associations between SDOH and high-acuity visits.
The sample's mean age was 46.8 years, with 68.5% females and 31.5% males. In adjusted models, the odds of high-acuity visit presentation was higher for males than females (odds ratio [OR]: 1.57; confidence interval [CI]: 1.22-2.01); non-Hispanic Blacks (OR: 2.21; CI: 1.58-3.09) as well as Hispanics/Latinos (OR: 2.10; CI:1.43-3.08) than Whites; unemployed (OR: 1.90; CI: 1.47-2.46.) than employed. Age was positively associated with high-acuity presentation. While GERD was associated with increased odds of high-acuity presentation (OR: 2.80; CI: 1.64-4.78), BMI, allergy, and depression did not have a statistically significant association with these visit types. These associations were independent of insurance coverage, which was not statistically associated with high-acuity visits.
SDOH and CMCs were associated with high-acuity healthcare presentation in adults with sinusitis. While this study highlights how SDOH affect healthcare usage patterns among people with sinusitis, further investigation is needed to identify and address the causes of these patterns.
健康的社会决定因素（SDOH）和合并症（CMCs）会影响就诊的紧迫性；然而，很少有研究探讨在鼻窦疾病的背景下这种关系。
本研究旨在描述社会决定因素和合并症与成年鼻窦炎患者就诊紧迫性之间的关系。
对 1842 名成年鼻窦炎患者在城市学术医疗中心就诊的病历（人口统计学、就诊类型和 ICD-10 代码）进行回顾性分析。采用卡方分析评估社会决定因素（年龄、种族/民族、性别、保险类型和就业状况）和合并症（抑郁、体重指数[BMI]、过敏和胃食管反流病[GERD]）与高紧迫性就诊类型（包括急诊和住院就诊）之间的关联。采用多变量二项逻辑回归检验社会决定因素与高紧迫性就诊之间的调整关联。
样本的平均年龄为 46.8 岁，女性占 68.5%，男性占 31.5%。在调整模型中，男性高紧迫性就诊的可能性高于女性（比值比[OR]：1.57；95%置信区间[CI]：1.22-2.01）；非西班牙裔黑人（OR：2.21；95%CI：1.58-3.09）和西班牙裔/拉丁裔（OR：2.10；95%CI：1.43-3.08）高于白人；失业（OR：1.90；95%CI：1.47-2.46）高于就业。年龄与高紧迫性就诊呈正相关。虽然 GERD 与高紧迫性就诊的可能性增加相关（OR：2.80；95%CI：1.64-4.78），但 BMI、过敏和抑郁与这些就诊类型没有统计学上的显著关联。这些关联独立于保险覆盖范围，而保险覆盖范围与高紧迫性就诊无统计学关联。
社会决定因素和合并症与成年鼻窦炎患者的高紧迫性医疗就诊相关。虽然这项研究强调了社会决定因素如何影响鼻窦炎患者的医疗服务使用模式，但需要进一步调查以确定和解决这些模式的原因。
