Disparities in Chronic Rhinosinusitis Outcomes and Income

Abstract

Objectives:

Chronic rhinosinusitis (CRS) is prevalent with high burden of disease. Both general health and disease-specific quality of life (QOL) measures have been found to significantly improve after endoscopic sinus surgery (ESS). It is also well known that social disparities in health are significant predictors for health outcomes. This study aimed to test the association between income and QOL outcomes in CRS.

Methods:

Patients were selected from a multicenter prospective cohort of adult CRS patients undergoing ESS (N=302). Outcomes included SF-36 general health QOL and disease-specific QOL as measured by the Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey (CSS). Linear regression was applied to test the association of income with QOL outcomes, controlling for significant covariates.

Results:

Multivariable regression demonstrated better QOL in the high-income group in all SF-36 domains (p=0.000-0.037) except mental health. There was no significant change in RSDI or CSS between income groups. Further, non-white patients in the low-income group demonstrated worse SF-36 QOL after ESS in comparison to their white counterparts.

Conclusions:

Within the general health domains, low-income minorities fared worse than their white counterparts in all SF-36 domains. Low-income minorities reported worse QOL after ESS in the SF-36 domains of physical function, physical role, and emotional role. These domains focus on limitations of work effectiveness or activities, which may disproportionately impact this population. Income is not significantly associated with disease-specific QOL. Low-income is associated with worse general health QOL in most domains. CRS-specific QOL surveys may fail to measure some important health outcomes.