Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Am J Rhinol Allergy. 2024 Jan;38(1):6-13. doi: 10.1177/19458924231204129. Epub 2023 Oct 5.
The purpose of this study is to characterize the presentation, outcomes, and barriers to care for White and non-White patients undergoing endoscopic sinus surgery (ESS).
ESS is often successful in providing long-term relief for patients suffering from chronic rhinosinusitis (CRS). Literature that uses robust measures of socioeconomic status (SES) and barriers to care to assess ESS outcomes is limited.
A retrospective matched cohort study of patients who underwent ESS for CRS between 1/1/2015 and 6/1/2021 at a single tertiary care academic center was conducted. White and non-White patients were matched 1-to-1 by sex and age (± 5 years). SES was evaluated using the area of deprivation index (ADI).
Of the 298 patients included in the study, 149 are White and 149 are non-White, 111 (37.2%) have CRS with nasal polyposis (CRSwNP), 141 (47.3%) had allergic rhinitis, 90 (30.2%) had asthma and 22 (7.4%) required revision ESS. Non-White patients were 3.62 times more likely to present with CRSwNP (95% confidence interval [CI] 2.2-5.96) and had 2.87 times increased odds for requiring revision ESS than age and sex-matched White patients (95% CI 1.090-7.545). The median ADI for non-White (6.00) patients was higher than for White patients (3.00) ( < .001) and 21.5% more non-White patients presented with Medicaid ( < .001).
Non-White patients undergoing ESS for CRS are more likely to present from areas with fewer resources and be underinsured. Using robust measures of SES, such as ADI, may allow for care to be tailored to patients with barriers to care.
本研究旨在描述白人患者和非白人患者接受内镜鼻窦手术（ESS）的表现、结局和就诊障碍。
ESS 通常可成功为慢性鼻-鼻窦炎（CRS）患者提供长期缓解。使用社会经济地位（SES）和就诊障碍的可靠措施来评估 ESS 结局的文献有限。
对 2015 年 1 月 1 日至 2021 年 6 月 1 日在一家三级学术医疗中心接受 ESS 治疗 CRS 的患者进行了回顾性匹配队列研究。白人患者和非白人患者按性别和年龄（±5 岁）1:1 匹配。SES 通过剥夺指数（ADI）进行评估。
在纳入研究的 298 名患者中，149 名为白人，149 名为非白人，111 名（37.2%）患有伴有鼻息肉（CRSwNP）的 CRS，141 名（47.3%）患有过敏性鼻炎，90 名（30.2%）患有哮喘，22 名（7.4%）需要进行翻修 ESS。非白人患者患 CRSwNP 的可能性是非白人患者的 3.62 倍（95%置信区间[CI] 2.2-5.96），需要翻修 ESS 的可能性是非白人患者的 2.87 倍，白人患者的年龄和性别相匹配（95%CI 1.090-7.545）。非白人患者的中位数 ADI（6.00）高于白人患者（3.00）（ < .001），21.5%的非白人患者使用医疗补助（ < .001）。
接受 ESS 治疗 CRS 的非白人患者更有可能来自资源较少的地区，并且保险不足。使用 SES 的可靠措施，如 ADI，可能使治疗能够根据有就诊障碍的患者进行调整。
