Health Care Disparities in Patients Undergoing Endoscopic Sinus Surgery for Chronic Rhinosinusitis: Differences in Disease Presentation and Access to Care

Duerson, Wes; Lafer, Marissa Purcelli; Ahmed, Omar; Bandler, Ilana; Wang, Binhuan; Lieberman, Seth; Lebowitz, Richard A.

doi:10.1177/0003489419834947

Cited by 21 publications

(21 citation statements)

References 33 publications

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“…Thirty-one articles were included in the final analysis after potentially overlapping studies were excluded. 19–49 Figure 1 provides a summary of the search process. The risk of bias graph is presented as percentages across all included studies and summarized in Figure 2.…”

Section: Resultsmentioning

confidence: 99%

Demographic Variation in Chronic Rhinosinusitis by Subtype and Region: A Systematic Review

Mehta

Nguyen

et al. 2021

Am J Rhinol�Allergy

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Background Chronic rhinosinusitis (CRS) describes a heterogenous group of diseases including CRS with (CRSwNP) or without nasal polyps (CRSsNP), aspirin-exacerbated respiratory disease (AERD), and allergic fungal rhinosinusitis (AFRS). It affects 10 to 15% of the US population and is more common in women and White patients. However, these estimates are based on survey and database studies with innate diagnostic inaccuracy. Additionally, few studies report subtype-specific demographics. We explore the demographic differences of CRS in the U.S. by subtype and region. Objective To characterize demographic differences between the CRS population and the overall US population, and also between different CRS subtype populations. Methods We performed a systematic review for articles reporting on US demographics of adults with CRS. Study participants were required to have been diagnosed using consensus criteria. Data on demographics, geographic region, and CRS subtype were analyzed. Results Our study analyzed 31 unique studies representing 8409 patients with 50.7% females and weighted mean age of 48.0 years. Compared to the overall US population, CRS patients were predominantly White (78.5%) and non-Hispanic (94.5%) with under-representation of other races. Grouped by subtype, CRSwNP affected a significantly higher proportion of men (59.8%). AFRS affected a significantly higher proportion of Black patients (53.8%) while CRSsNP was more prevalent in White patients (84.2%). When grouped by region, the South had a significantly higher proportion of female (53%) and Black (17.8%) CRS patients. The West had a significantly higher proportion of Asian (4.5%) and Hispanic (12.3%) patients. Conclusions Significant demographic differences exist in CRS patients based on subtype and region. These data provide an estimation of the demographic make-up of CRS, but further high-level demographic studies are needed.

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Section: Resultsmentioning

confidence: 99%

Demographic Variation in Chronic Rhinosinusitis by Subtype and Region: A Systematic Review

Mehta

Nguyen

et al. 2021

Am J Rhinol�Allergy

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“…40 Duerson et al demonstrated that patients with CRS at a public hospital were more likely to be non-White, have nasal polyposis, and have CRS symptoms for 21% longer, likely secondary to decreased access to specialty care. 41 Previously published literature has also demonstrated racial disparities in rhinology treatment. When controlling for insurance and income status, Woodard et al found that Black and Hispanic individuals underwent ESS at significantly lower rates than White patients.…”

Section: Discussionmentioning

confidence: 99%

Race in Rhinology Clinical Trials: A Decade of Disparity

et al. 2021

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The aim of this study is to assess the ethnic and racial demographics of patients enrolled in prospective chronic rhinosinusitis (CRS) studies relative to the corresponding geographic demographics of the United States (U.S.) census data.Study Design: Systematic Review and Population analysis. Methods: A systematic review was performed to identify CRS clinical trials, conducted in the U.S. and published between 2010 and 2020 in which patients were prospectively enrolled. Pooled racial and ethnicity data were compared to national and corresponding regional census data.Results: Eighty-three studies were included, comprising 12,027 patients. 50.4% were male and the average age was 49.2 years. 8,810 patients underwent a surgical procedure. Of the 12,027 patients, 81.67% were identified as White, 5.35% as Black, 1.27% as Asian, 0.02% as Pacific Islander, 0.12% as American Indian, and 11.57% were classified as Other. The racial and ethnic composition of the pooled study population differs significantly from the national U.S. census data with the underrepresentation of each minority population (P ≤ .0002). Regional sub-analyses yield variable results. In the Northeast and West, there was an underrepresentation of all minority populations. In the South and Midwest, Black enrollment was similar to the U.S. census data, while all other minorities were underrepresented.Conclusions: The racial and ethnic composition of patients enrolled in prospective CRS clinical trials differs significantly from the demographics of the U.S. population. The generalizability and external validity of findings derived from studies comprised of demographically mismatched populations has not been established. Future efforts to enroll more representative populations should be emphasized by the research community, funding bodies, and editorial boards.

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“…Thus, the potential interaction between nasal cavity breadth, NF orientation, and sinusitis remains unclear. Regardless, compared to the distinct MS morphology seen in our Asian sample, we would argue that these relatively minor differences in MS and NF morphology between individuals of European and African ancestry are less likely to contribute to health disparities between these populations compared to other known factors such as socioeconomic status, environmental stress, and access to healthcare (Duerson et al, 2019;Soler et al, 2012).…”

Section: Discussionmentioning

confidence: 70%

Ancestry‐based variation in maxillary sinus anatomy: Implications for health disparities in sinonasal disease

Kim

Ward

Butaric

et al. 2021

The Anatomical Record

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Paranasal sinus drainage is mediated by mucociliary transport and gravity.However, human orthograde posture, along with the superior positioning of the maxillary sinus (MS) ostium, increases reliance on the mucociliary system.Previous research has thus suggested that differences in MS size and shape may impede mucociliary clearance, potentially contributing to disparities in sinusitis susceptibility. To further investigate this hypothesis, this study collected 29 three-dimensional (3D) coordinate landmarks and seven linear measurements of MS morphology from 167 computed tomography (CT) scans of crania of European, East Asian, or Equatorial African ancestry. MANOVA results reveal the Asian-derived individuals are characterized by both a significantly taller MS (F = 14.15, p < 0.0001) and a significantly greater distance from the MS floor to the ostium (F = 17.22, p < 0.0001) compared to those of European and African ancestry. A canonical variate (CV) analysis conducted on 3D landmark data provides corroborative results, distinguishing Asianderived individuals predominantly on the basis of a relatively lower MS floor.As a greater distance between the MS floor and ostium may impede mucociliary clearance, our results suggest MS anatomy may be a more prominent factor in chronic sinusitis among individuals of Asian ancestry compared to those of European and African ancestries. This provides tentative evidence of an anatomical etiology for chronic sinusitis even in the absence of anatomical variants/abnormalities (e.g., nasal polyps, concha bullosa, Haller's cells, and Agger nasi cells). Further research into the relationship between MS anatomy and sinusitis, in addition to socioeconomic inequalities of healthcare, is warranted to continue evaluating possible contributions to health disparities.

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Health Care Disparities in Patients Undergoing Endoscopic Sinus Surgery for Chronic Rhinosinusitis: Differences in Disease Presentation and Access to Care

Cited by 21 publications

References 33 publications

Demographic Variation in Chronic Rhinosinusitis by Subtype and Region: A Systematic Review

Demographic Variation in Chronic Rhinosinusitis by Subtype and Region: A Systematic Review

Race in Rhinology Clinical Trials: A Decade of Disparity

Ancestry‐based variation in maxillary sinus anatomy: Implications for health disparities in sinonasal disease

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