2018 Section 5 - Rhinology and Allergic Disorders

Lu-Myers et al

Figure 1. Health Services Areas (HAS) of North Carolina with respective distribution of patients with chronic rhinosinusitis.

assess demographic and socioeconomic variables and char- acteristics of disease severity in the 2 groups of patients with AFRS and CRS (further stratified into CRSwNP and CRSsNP). The CRS group was stratified into CRSsNP and CRSwNP due to the heterogeneity of CRS and to investi- gate whether either group would differ in terms of disease severity, demographic factors, or indicators of socioeco- nomic status. Fisher’s exact tests and Pearson’s chi-square test were used to assess associations in categorical variables to determine differences between observed and expected frequencies or percentages. For continuous variables, Wilcoxon rank sum and Kruskal-Wallis tests were used to compare associations. Last, associations between demo- graphic characteristics and markers of disease severity within the CRS group were assessed using Wilcoxon rank sum and Kruskal-Willis tests. Data were analyzed using SAS version 9.2 (SAS Institute, Cary, North Carolina). Statistical significance was defined by a 2-sided alpha of .05. Results Demographic, County-Specific, and Disease Severity Characteristics in CRS Patients The CRS cohort consisted of 93 patients. Baseline charac- teristics of the patients are shown in Table 1 . The average age at presentation and diagnosis was 44 years, with a range of 13 to 71 years. The population consisted of 48 (52%) males and 45 (48%) females; 69 (76%) subjects were white, 14 (15%) were African American, 2 (2%) were Asian, and 6 (7%) were Hispanic. The majority of the patients, 53 (60%), had private insurance. Among the rest, 10 (11%) were cov- ered by Medicare, 7 (8%) were covered by military insur- ance, and 18 (21%) were self-pay or were covered by subsidized programs like Medicaid. Markers of disease severity for the CRS cohorts are shown in Table 2 . Among the 93 patients, 61 (66%) CRS patients had nasal polyposis, 40 (43%) had asthma, and 57 (61%) had allergic rhinitis. They had an average quantitative

serum IgE level of 352 IU/mL. Average Lund-Mackay score was 11.3 out of 24, or 47% of the total maximum score.

Differences in Demographic, County-Specific, and Disease Severity Characteristics between AFRS, CRSwNP, and CRSsNP Patients Differences in demographic and county-specific socioeco- nomic status markers between the groups are shown in Table 1 . The CRS patients were further divided into CRSwNP (n = 61, 66%) and CRSsNP (n = 32, 34%), and the subgroups were also compared with AFRS. In terms of demographics, both CRSsNP and CRSwNP patients were older than AFRS patients at the time of presentation (44 [CRSsNP] vs 44 [CRSwNP] vs 29 [AFRS] years old; P \ .0001). The 2 groups of CRS (CRSwNP and CRSsNP) patients had a smaller African American popu- lation compared with AFRS patients (16% vs 15% vs 59%, respectively; P \ .0001). For county-specific data, CRS patients with and without nasal polyposis (NP) had higher annual income per capita compared with AFRS patients ($27,457 vs $27,655 vs $25,168, respectively; P = .01). In terms of access to primary care providers, all CRS patients compared with AFRS patients had more pri- mary care providers per 100 residents (0.13 vs 0.1; P = .03). Several important but expected differences existed between the AFRS and CRS patients for markers of disease severity, and these differences are shown in Table 2 . Average quantitative serum IgE level was higher for AFRS patients (1030 IU/mL) than CRS patients (CRSwNP 429 IU/mL and CRSsNP 212 IU/mL; P \ .0001). Average Lund-Mackay score was also higher in AFRS patients (16) compared with CRS patients (CRSwNP 13 and CRSsNP 8; P \ .0001). CRS patients with and without NP, compared with AFRS patients, were less likely to have allergic rhinitis (50% vs 67% vs 88%, respectively; P . .0001) and to receive subcutaneous immunotherapy (13% vs 31% vs 53%, respectively; P \ .0001).

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