Hirsch Annemarie G, Schwartz Brian S, Nordberg Cara M, Tan Bruce K, Schleimer Robert P, Kern Robert C, Peters Anju T, Bandeen-Roche Karen, Lehmann Ashton E
Department of Population Health Sciences, Geisinger Health System, 100 N. Academy Avenue, Danville, PA, 17822-4400, USA.
Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA.
BMC Health Serv Res. 2025 May 20;25(1):724. doi: 10.1186/s12913-025-12882-8.
An understanding of future healthcare needs of patients with chronic rhinosinusitis (CRS) is essential for patients and providers to make informed treatment decisions. Data on the predictors of long-term CRS-related healthcare utilization are limited. While there is evidence of sex differences in CRS, it is unknown whether the factors associated with long-term healthcare needs differ by sex.
The objectives of this study were to evaluate associations between CRS symptoms and CRS-related healthcare utilization and how these associations differ by sex.
We conducted a prospective study of 7,847 subjects, utilizing questionnaire and electronic health record data to assess CRS-related healthcare utilization. Individuals who met CRS symptom criteria were categorized into one of four symptom profiles in 2014: obstruction and discharge; pain or pressure without smell loss; smell loss without pain or pressure; and pain or pressure and smell loss. Healthcare utilization (2014-2019) was classified into one of six categories based on CRS-related clinical encounters and diagnostic imaging: minimal overall utilization, no CRS-related utilization; one-year of CRS-related utilization; repeated CRS-related utilization; episodic CRS-related utilization; and discontinued utilization. We evaluated associations between symptom profiles and utilization categories using multinomial logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI), assessing effect modification by sex using cross-product terms.
Of the 7,847 subjects, 62.7% were women and 37.3% were men. Among women, there was no association between CRS symptoms in 2014 and repeated CRS-related healthcare utilization (versus discontinued CRS-related utilization), whereas men with CRS symptoms had nearly twice the odds (OR 1.81 CI: 1.02, 3.20) of repeated utilization. Women who had CRS with pain and pressure, had higher odds of discontinued CRS-related utilization. This was not observed for other symptom profiles.
Healthcare utilization patterns for CRS varied by symptoms and sex. Women with facial pain/pressure were uniquely at risk for discontinuation of CRS-related care, providing further evidence of sex differences among individuals reporting sinonasal symptoms.
了解慢性鼻窦炎（CRS）患者未来的医疗保健需求对于患者和医疗服务提供者做出明智的治疗决策至关重要。关于长期CRS相关医疗保健利用预测因素的数据有限。虽然有证据表明CRS存在性别差异，但尚不清楚与长期医疗保健需求相关的因素是否因性别而异。
本研究的目的是评估CRS症状与CRS相关医疗保健利用之间的关联，以及这些关联如何因性别而异。
我们对7847名受试者进行了一项前瞻性研究，利用问卷和电子健康记录数据来评估CRS相关的医疗保健利用情况。符合CRS症状标准的个体在2014年被分为四种症状类型之一：鼻塞和流涕；疼痛或压痛但无嗅觉丧失；嗅觉丧失但无疼痛或压痛；疼痛或压痛且嗅觉丧失。根据与CRS相关的临床就诊和诊断成像，将2014 - 2019年的医疗保健利用情况分为六类之一：总体利用极少，无CRS相关利用；一年的CRS相关利用；反复的CRS相关利用；间歇性CRS相关利用；以及停止利用。我们使用多项逻辑回归来估计优势比（OR）和95%置信区间（CI），以评估症状类型与利用类别之间的关联，并使用交叉乘积项评估性别对效应的修正作用。
在7847名受试者中，62.7%为女性，37.3%为男性。在女性中，2014年的CRS症状与反复的CRS相关医疗保健利用（相对于停止CRS相关利用）之间没有关联，而有CRS症状的男性反复利用的几率几乎是两倍（OR 1.81，CI：1.02，3.20）。患有疼痛和压痛的CRS女性停止CRS相关利用的几率更高。其他症状类型未观察到这种情况。
CRS的医疗保健利用模式因症状和性别而异。面部疼痛/压痛的女性在停止CRS相关护理方面有独特的风险，这为报告鼻窦症状的个体之间的性别差异提供了进一步的证据。
