Gill Amarbir S, Tullis Benton, Mace Jess C, Massey Conner, Pandrangi Vivek C, Gutierrez Jorge A, Ramakrishnan Vijay R, Beswick Daniel M, Soler Zachary M, Smith Timothy L, Alt Jeremiah A
Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA.
Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah, USA.
Int Forum Allergy Rhinol. 2024 Aug;14(8):1302-1313. doi: 10.1002/alr.23337. Epub 2024 Feb 17.
Socioeconomic status (SES) is linked to health outcomes but has not been well studied in patients with chronic rhinosinusitis (CRS). The area deprivation index (ADI) is a comprehensive measure of geographic SES that ranks neighborhood disadvantage. This investigation used ADI to understand the impact of neighborhood disadvantage on CRS treatment outcomes.
A total of 642 study participants with CRS were prospectively enrolled and self-selected endoscopic sinus surgery (ESS) or continued appropriate medical therapy as treatment. The 22-item SinoNasal Outcome Test (SNOT-22) and Medical Outcomes Study Questionnaire Short-Form 6-D (SF-6D) health utility value scores were recorded pre- and post-treatment. Using residence zip codes, national ADI scores were retrospectively assigned to patients. Spearman's correlation coefficients (Rs) and Cramer's V effect size (φ) with 95% confidence interval (CI) were calculated.
A history of ESS was associated with significantly worse ADI scores compared to no history of ESS (φ = 0.18; 95% CI: 0.10, 0.25; p < 0.001). Baseline total SNOT-22 (Rs = 0.14; 95% CI: 0.06, 0.22; p < 0.001) and SF-6D values (Rs = -0.20; 95% CI: -0.27, -0.12; p < 0.001) were significantly negatively correlated with national ADI rank. No significant correlations between ADI and within-subject improvement, or achievement of >1 minimal clinically important difference, in SNOT-22 or SF-6D scores after treatment were found.
Geographic socioeconomic deprivation was associated with worse baseline disease severity and history of prior surgical intervention. However, ADI did not correlate with improvement in disease-specific outcomes. The impact of socioeconomic deprivation on outcomes in CRS requires further investigation.
社会经济地位（SES）与健康结果相关，但在慢性鼻-鼻窦炎（CRS）患者中尚未得到充分研究。区域剥夺指数（ADI）是一种衡量地理区域SES的综合指标，用于对社区劣势进行排名。本研究使用ADI来了解社区劣势对CRS治疗结果的影响。
前瞻性纳入642名CRS研究参与者，他们自行选择接受鼻内镜鼻窦手术（ESS）或继续进行适当的药物治疗。在治疗前后记录22项鼻-鼻窦结局测试（SNOT-22）和医学结局研究问卷简表6维度（SF-6D）健康效用值评分。利用居住邮编，回顾性地为患者分配全国ADI评分。计算Spearman相关系数（Rs）和Cramer's V效应量（φ）及其95%置信区间（CI）。
与无ESS病史相比，有ESS病史的患者ADI评分显著更差（φ = 0.18；95% CI：0.10，0.25；p < 0.001）。基线总SNOT-22评分（Rs = 0.14；95% CI：0.06，0.22；p < 0.001）和SF-6D值（Rs = -0.20；95% CI：-0.27，-0.12；p < 0.001）与全国ADI排名显著负相关。治疗后，未发现ADI与SNOT-22或SF-6D评分的受试者内改善或达到>1个最小临床重要差异之间存在显著相关性。
地理区域的社会经济剥夺与更差的基线疾病严重程度和既往手术干预史相关。然而，ADI与疾病特异性结局的改善无关。社会经济剥夺对CRS结局的影响需要进一步研究。
