Impact of sociodemographic status and sex on chronic rhinosinusitis and olfaction in people with cystic fibrosis.
chronic rhinosinusitis
cystic fibrosis
patient symptoms
socioeconomic status
Journal
International forum of allergy & rhinology
ISSN: 2042-6984
Titre abrégé: Int Forum Allergy Rhinol
Pays: United States
ID NLM: 101550261
Informations de publication
Date de publication:
05 Jul 2024
05 Jul 2024
Historique:
revised:
19
06
2024
received:
27
05
2024
accepted:
23
06
2024
medline:
5
7
2024
pubmed:
5
7
2024
entrez:
5
7
2024
Statut:
aheadofprint
Résumé
Sociodemographic status (SDS) including race/ethnicity and socioeconomic status as approximated by education, income, and insurance status impact pulmonary disease in people with cystic fibrosis (PwCF). The relationship between SDS and chronic rhinosinusitis (CRS) remains understudied. In a prospective, multi-institutional study, adult PwCF completed the 22-Question SinoNasal Outcome Test (SNOT-22), Smell Identification Test (SIT), Questionnaire of Olfactory Disorder Negative Statements (QOD-NS), and Cystic Fibrosis Questionnaire-Revised (CFQ-R). Lund-Kennedy scores, sinus computed tomography, and clinical data were collected. Data were analyzed across race/ethnicity, sex, and socioeconomic factors using multivariate regression. Seventy-three PwCF participated with a mean age of 34.7 ± 10.9 years and 49 (67.1%) were female. Linear regression identified that elexacaftor/tezacaftor/ivacaftor (ETI) use (β = ‒4.09, 95% confidence interval [CI] [‒6.08, ‒2.11], p < 0.001), female sex (β = ‒2.14, 95% CI [‒4.11, ‒0.17], p = 0.034), and increasing age (β = ‒0.14, 95% CI [‒0.22, ‒0.05], p = 0.003) were associated with lower/better endoscopy scores. Private health insurance (β = 17.76, 95% CI [5.20, 30.32], p = 0.006) and >16 educational years (β = 13.50, 95% CI [2.21, 24.80], p = 0.020) were associated with higher baseline percent predicted forced expiratory volume in one second (ppFEV Differences in objective measures of CRS severity exist among PwCF related to sex, age, and ETI use. Variant status and race did not influence patient-reported CRS severity measures or olfaction in this study. Understanding how these factors impact response to treatment may improve care disparities among PwCF. NCT04469439.
Sections du résumé
BACKGROUND
BACKGROUND
Sociodemographic status (SDS) including race/ethnicity and socioeconomic status as approximated by education, income, and insurance status impact pulmonary disease in people with cystic fibrosis (PwCF). The relationship between SDS and chronic rhinosinusitis (CRS) remains understudied.
METHODS
METHODS
In a prospective, multi-institutional study, adult PwCF completed the 22-Question SinoNasal Outcome Test (SNOT-22), Smell Identification Test (SIT), Questionnaire of Olfactory Disorder Negative Statements (QOD-NS), and Cystic Fibrosis Questionnaire-Revised (CFQ-R). Lund-Kennedy scores, sinus computed tomography, and clinical data were collected. Data were analyzed across race/ethnicity, sex, and socioeconomic factors using multivariate regression.
RESULTS
RESULTS
Seventy-three PwCF participated with a mean age of 34.7 ± 10.9 years and 49 (67.1%) were female. Linear regression identified that elexacaftor/tezacaftor/ivacaftor (ETI) use (β = ‒4.09, 95% confidence interval [CI] [‒6.08, ‒2.11], p < 0.001), female sex (β = ‒2.14, 95% CI [‒4.11, ‒0.17], p = 0.034), and increasing age (β = ‒0.14, 95% CI [‒0.22, ‒0.05], p = 0.003) were associated with lower/better endoscopy scores. Private health insurance (β = 17.76, 95% CI [5.20, 30.32], p = 0.006) and >16 educational years (β = 13.50, 95% CI [2.21, 24.80], p = 0.020) were associated with higher baseline percent predicted forced expiratory volume in one second (ppFEV
CONCLUSIONS
CONCLUSIONS
Differences in objective measures of CRS severity exist among PwCF related to sex, age, and ETI use. Variant status and race did not influence patient-reported CRS severity measures or olfaction in this study. Understanding how these factors impact response to treatment may improve care disparities among PwCF.
CLINICAL TRIALS
RESULTS
NCT04469439.
Banques de données
ClinicalTrials.gov
['NCT04469439']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Cystic Fibrosis Foundation
ID : BESWIC20A0
Organisme : Cystic Fibrosis Foundation
ID : BESWIC22Y5
Organisme : National Institute on Deafness and Other Communication Disorders of the National Institutes of Health
ID : R25DC020151
Informations de copyright
© 2024 The Authors. International Forum of Allergy & Rhinology published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngic Allergy and American Rhinologic Society.
Références
Krajewska J, Zub K, Slowikowski A, Zatonski T. Chronic rhinosinusitis in cystic fibrosis: a review of therapeutic options. Eur Arch Otorhinolaryngol. 2022;279(1):1‐24. doi:10.1007/s00405‐021‐06875‐6
Oates GR, Schechter MS. Socioeconomic status and health outcomes: cystic fibrosis as a model. Expert Rev Respir Med. 2016;10(9):967‐977. doi:10.1080/17476348.2016.1196140
Oates GR, Schechter MS. Aiming to improve equity in pulmonary health: cystic fibrosis. Clin Chest Med. 2023;44(3):555‐573. doi:10.1016/j.ccm.2023.03.011
Gudis DA, Schlosser RJ. The Unified Airway: Rhinologic Disease and Respiratory Disorders. Springer International Publishing; 2020.
Duerson W, Lafer M, Ahmed O, et al. Health care disparities in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis: differences in disease presentation and access to care. Ann Otol Rhinol Laryngol. 2019;128(7):608‐613. doi:10.1177/0003489419834947
Peterson R, Keswani A. The impact of social determinants and air pollution on healthcare disparities in chronic rhinosinusitis with nasal polyps. Am J Rhinol Allergy. 2023;37(2):147‐152. doi:10.1177/19458924231153483
Hagedorn R, Tullis B, Nguyen C, et al. Does air pollutant exposure impact disease severity or outcomes in chronic rhinosinusitis? Int Forum Allergy Rhinol. 2023;14(4):755‐764. doi:10.1002/alr.23250
Velasquez N, Gardiner L, Cheng TZ, et al. Relationship between socioeconomic status, exposure to airborne pollutants, and chronic rhinosinusitis disease severity. Int Forum Allergy Rhinol. 2022;12(2):172‐180. doi:10.1002/alr.22884
Beswick DM, Han EJ, Mace JC, et al. Factors that predict pursuing sinus surgery in the era of highly effective modulator therapy. Int Forum Allergy Rhinol. 2023;14(4):807‐818. doi:10.1002/alr.23270
Han EJ, Beswick DM, Eshaghian PH, et al. Decreases in rhinology care utilization by people with cystic fibrosis on highly effective modulator therapy. Ann Otol Rhinol Laryngol. 2024;133(3):340‐344. doi:10.1177/00034894231211626
McGarry ME, McColley SA. Cystic fibrosis patients of minority race and ethnicity less likely eligible for CFTR modulators based on CFTR genotype. Pediatr Pulmonol. 2021;56(6):1496‐1503. doi:10.1002/ppul.25285
Desai M, Hine C, Whitehouse JL, Brownlee K, Charman SC, Nagakumar P. Who are the 10%?—Non eligibility of cystic fibrosis (CF) patients for highly effective modulator therapies. Respir Med. 2022;199:106878. doi:10.1016/j.rmed.2022.106878
Jordan K, Vigers T, Taylor‐Cousar JL, Sagel SD. Disparities in elexacaftor/tezacaftor/ivacaftor initiation in the US cystic fibrosis population. Pediatr Pulmonol. 2024. doi:10.1002/ppul.27040
Liu CM, Han EJ, Fischer JL, et al. Patient perspectives on chronic rhinosinusitis in cystic fibrosis: symptom prioritization in the era of highly effective modulator therapy. Int Forum Allergy Rhinol. 2024. doi:10.1002/alr.23332
Orlandi RR, Kingdom TT, Smith TL, et al. International consensus statement on allergy and rhinology: rhinosinusitis 2021. Int Forum Allergy Rhinol. 2021;11(3):213‐739. doi:10.1002/alr.22741
Rosenfeld RM. Clinical practice guideline on adult sinusitis. Otolaryngol Head Neck Surg. 2007;137(3):365‐377. doi:10.1016/j.otohns.2007.07.021
Thompson WE, Hickey JV. Society in Focus: An Introduction to Sociology. 6th ed.. Pearson/Allyn and Bacon; 2008:xxi. 650 p.
Pharmaceuticals V. Am I Eligible for Trikafta? Accessed June 12, 2024. https://www.trikafta.com/who‐trikafta‐is‐for
Hopkins C, Gillett S, Slack R, Lund VJ, Browne JP. Psychometric validity of the 22‐item Sinonasal Outcome Test. Clin Otolaryngol. 2009;34(5):447‐454. doi:10.1111/j.1749‐4486.2009.01995.x
DeConde AS, Bodner TE, Mace JC, Smith TL. Response shift in quality of life after endoscopic sinus surgery for chronic rhinosinusitis. JAMA Otolaryngol Head Neck Surg. 2014;140(8):712‐719. doi:10.1001/jamaoto.2014.1045
Quittner AL, Buu A, Messer MA, Modi AC, Watrous M. Development and validation of the Cystic Fibrosis Questionnaire in the United States: a health‐related quality‐of‐life measure for cystic fibrosis. Chest. 2005;128(4):2347‐2354. doi:10.1378/chest.128.4.2347
Mattos JL, Schlosser RJ, DeConde AS, et al. Factor analysis of the questionnaire of olfactory disorders in patients with chronic rhinosinusitis. Int Forum Allergy Rhinol. 2018;8(7):777‐782. doi:10.1002/alr.22112
Doty RL. The Smell Identification Test Administration Manual. 3rd ed. Sensonics, Inc.; 1995.
Doty RL, Shaman P, Dann M. Development of the University of Pennsylvania Smell Identification Test: a standardized microencapsulated test of olfactory function. Physiol Behav. 1984;32(3):489‐502. doi:10.1016/0031‐9384(84)90269‐5
Lund VJ, Kennedy DW. Staging for rhinosinusitis. Otolaryngol Head Neck Surg. 1997;117(3 Pt 2):S35‐S40. doi:10.1016/S0194‐59989770005‐6
Lund VJ, Mackay IS. Staging in rhinosinusitus. Rhinology. 1993;31(4):183‐184.
Chatterjee S, Simonoff JS. Handbook of Regression Analysis. Wiley; 2013:1.
Taylor‐Robinson DC, Smyth RL, Diggle PJ, Whitehead M. The effect of social deprivation on clinical outcomes and the use of treatments in the UK cystic fibrosis population: a longitudinal study. Lancet Respir Med. 2013;1(2):121‐128. doi:10.1016/S2213‐2600(13)70002‐X
Schechter MS, Shelton BJ, Margolis PA, Fitzsimmons SC. The association of socioeconomic status with outcomes in cystic fibrosis patients in the United States. Am J Respir Crit Care Med. 2001;163(6):1331‐1337. doi:10.1164/ajrccm.163.6.9912100
Ramos L, Massey CJ, Asokan A, Rice JD, Kroehl M, Ramakrishnan VR. Examination of sex differences in a chronic rhinosinusitis surgical cohort. Otolaryngol Head Neck Surg. 2022;167(3):583‐589. doi:10.1177/01945998221076468
Lal D, Rounds AB, Divekar R. Gender‐specific differences in chronic rhinosinusitis patients electing endoscopic sinus surgery. Int Forum Allergy Rhinol. 2016;6(3):278‐286. doi:10.1002/alr.21667
Asokan A, Mace JC, Rice JD, Smith TL, Soler ZM, Ramakrishnan VR. Sex differences in presentation and surgical outcomes from a prospective multicenter chronic rhinosinusitis study. Otolaryngol Head Neck Surg. 2023;168(3):491‐500. doi:10.1177/01945998221102810
Behnke J, Dundervill C, Al‐Asadi Z, Shahid M, Ramadan HH, Makary CA. Gender differences in adults with chronic rhinosinusitis: a scoping review. Otolaryngol Head Neck Surg. 2024;170(6):1659‐1667. doi:10.1002/ohn.663
Espersen J, Weber U, Romer‐Franz A, Lenarz T, Stolle SRO, Warnecke A. Level of sex hormones and their association with acetylsalicylic acid intolerance and nasal polyposis. PLoS One. 2020;15(12):e0243732. doi:10.1371/journal.pone.0243732
Zhang Y, Wang X, Zhang W, Han D, Zhang L, Bachert C. Polymorphisms in thymic stromal lymphopoietin gene demonstrate a gender and nasal polyposis‐dependent association with chronic rhinosinusitis. Hum Immunol. 2013;74(2):241‐248. doi:10.1016/j.humimm.2012.11.004
Adams DR, Xu LJ, Vickery TW, et al. The impact of gender on long‐term quality of life after sinus surgery for chronic rhinosinusitis. Laryngoscope. 2023;133(12):3319‐3326. doi:10.1002/lary.30719
Morse JC, Li P, Ely KA, et al. Chronic rhinosinusitis in elderly patients is associated with an exaggerated neutrophilic proinflammatory response to pathogenic bacteria. J Allergy Clin Immunol. 2019;143(3):990‐1002.e6. doi:10.1016/j.jaci.2018.10.056
Kim YS, Kim NH, Seong SY, Kim KR, Lee GB, Kim KS. Prevalence and risk factors of chronic rhinosinusitis in Korea. Am J Rhinol Allergy. 2011;25(3):117‐121. doi:10.2500/ajra.2011.25.3630
Vaitkus J, Vitkauskiene A, Simuntis R, Vaitkus Z, Siupsinskiene N, Vaitkus S. Chronic rhinosinusitis with nasal polyps: age and disease severity differences in the levels of inflammatory markers. Medicina (Kaunas). 2021;57(3):282. doi:10.3390/medicina57030282
Holmes T, Makary C, Unsal AA, Biddinger P, Reyes‐Gelves C, Kountakis SE. How does age impact presentation and outcomes in chronic rhinosinusitis? Ann Otol Rhinol Laryngol. 2020;129(9):872‐877. doi:10.1177/0003489420919124
Di Lorenzo G, Leto‐Barone MS, La Piana S, Ditta V, Di Fede G, Rini GB. Clinical course of rhinitis and changes in vivo and in vitro of allergic parameters in elderly patients: a long‐term follow‐up study. Clin Exp Med. 2013;13(1):67‐73. doi:10.1007/s10238‐012‐0175‐8
Sobol SE, Christodoulopoulos P, Manoukian JJ, et al. Cytokine profile of chronic sinusitis in patients with cystic fibrosis. Arch Otolaryngol Head Neck Surg. 2002;128(11):1295‐1298. doi:10.1001/archotol.128.11.1295
Lucas SK, Feddema E, Boyer HC, Hunter RC. Diversity of cystic fibrosis chronic rhinosinusitis microbiota correlates with different pathogen dominance. J Cyst Fibros. 2021;20(4):678‐681. doi:10.1016/j.jcf.2021.03.022
Hsiang WR, Lukasiewicz A, Gentry M, et al. Medicaid patients have greater difficulty scheduling health care appointments compared with private insurance patients: a meta‐analysis. Inquiry. 2019;56:46958019838118. doi:10.1177/0046958019838118
Gill AS, Tullis B, Mace JC, et al. Health care disparities and chronic rhinosinusitis: does neighborhood disadvantage impact outcomes in sinonasal disease? Int Forum Allergy Rhinol. 2024. doi:10.1002/alr.23337
Durda‐Masny M, Gozdzik‐Spychalska J, John A, et al. The determinants of survival among adults with cystic fibrosis‐a cohort study. J Physiol Anthropol. 2021;40(1):19. doi:10.1186/s40101‐021‐00269‐7
Oates GR, Stepanikova I, Gamble S, Gutierrez HH, Harris WT. Adherence to airway clearance therapy in pediatric cystic fibrosis: socioeconomic factors and respiratory outcomes. Pediatr Pulmonol. 2015;50(12):1244‐1252. doi:10.1002/ppul.23317
Shen SA, Jafari A, Qualliotine JR, DeConde AS. Socioeconomic and demographic determinants of postoperative outcome after endoscopic sinus surgery. Laryngoscope. 2020;130(2):297‐302. doi:10.1002/lary.28036
Beswick DM, Mace JC, Rudmik L, et al. Socioeconomic factors impact quality of life outcomes and olfactory measures in chronic rhinosinusitis. Int Forum Allergy Rhinol. 2019;9(3):231‐239. doi:10.1002/alr.22256
Quittner AL, Schechter MS, Rasouliyan L, Haselkorn T, Pasta DJ, Wagener JS. Impact of socioeconomic status, race, and ethnicity on quality of life in patients with cystic fibrosis in the United States. Chest. 2010;137(3):642‐650. doi:10.1378/chest.09‐0345
Beswick DM, Humphries SM, Balkissoon CD, et al. Impact of cystic fibrosis transmembrane conductance regulator therapy on chronic rhinosinusitis and health status: deep learning CT analysis and patient‐reported outcomes. Ann Am Thorac Soc. 2022;19(1):12‐19. doi:10.1513/AnnalsATS.202101‐057OC
Stapleton AL, Kimple AJ, Goralski JL, et al. Elexacaftor‒tezacaftor‒ ivacaftor improves sinonasal outcomes in cystic fibrosis. J Cyst Fibros. 2022;21(5):792‐799. doi:10.1016/j.jcf.2022.03.002
Registry CFFP. Annual Data Report 2021. 2021.