Race and Area of Deprivation Index Predict Outcomes of Endoscopic Sinus Surgery for Chronic Sinusitis

Abstract

Objective 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). Background 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. Methods 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). Results 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) ( P < .001) and 21.5% more non-White patients presented with Medicaid ( P < .001). Conclusion 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.

You Do Not Rise to the Level of Your Goals; You Fall to the Level of Your Systems

“…Hentati and colleagues conducted a retrospective matched cohort study analyzing the impact of race and socioeconomic status on presentation and outcomes in patients with chronic rhinosinusitis (CRS) undergoing endoscopic sinus surgery. 1 They found that nonwhite patients have worse outcomes, higher revision rates, less consistent follow up, and present from areas with fewer resources compared to white patients. Therefore, acknowledging the socioeconomic status is essential when treating patients with CRS in order to mitigate disparity-related outcomes.…”