Evaluation of Disparities in Management of Chronic Rhinosinusitis by Race and Ethnicity: An All of Us Research Program Study

Abstract

Objective

To evaluate disparities in the management of chronic rhinosinusitis (CRS) across racial, ethnic, and gender groups, focusing on treatment patterns and associated comorbidities.

Methods

This cross-sectional study analyzed data from 28,278 adults with CRS in the NIH All of Us Research Program between 2018 and 2022. Multivariable logistic regression was used to assess associations between demographic variables, associated comorbidities, and receipt of treatments including systemic steroids, leukotriene modifiers, antibiotics, biologics, and sinus surgery.

Results

Black individuals had higher odds of receiving systemic steroids (OR: 1.59, P < .0001) and antibiotics (OR: 1.67, P < .0001), but were less likely to receive biologics (OR: 0.30, P = .051). Non-Hispanic individuals were more likely to receive systemic steroids (OR: 1.54, P < .001) and antibiotics (OR: 1.54, P = .0007), but were less likely to undergo sinus surgery (OR: 0.67, P = .016). Male sex was associated with reduced odds of receiving systemic steroids (OR: 0.86, P < .0001), leukotriene modifiers (OR: 0.81, P < .001), and antibiotics (OR: 0.91, P < .001) but increased odds of undergoing surgery (OR: 1.37, P < .0001). Presence of nasal polyps and comorbid asthma strongly predicted use of biologics (ORs: 4.39 and 13.83, respectively, P < .0001) and surgical intervention (ORs: 13.13 and 1.34, respectively, P < .0001).

Conclusion

Significant racial, ethnic, and gender disparities exist in the treatment of CRS, independent of comorbidities. These findings highlight the need for equity-focused strategies to ensure timely access to advanced therapies and to address structural barriers that may influence treatment allocation.