Socioeconomic status impacts postoperative productivity loss and health utility changes in refractory chronic rhinosinusitis

Evaluating health utility score through direct and indirect methods in patients with chronic rhinosinusitis

INTRODUCTION

EuroQol-5-dimensions-5-levels (EQ-5D-5L), visual analog scale (VAS), time trade-off (TTO), and standard gamble (SG) are used for the assessment of Health Utility Scores (HUS) of chronic rhinosinusitis (CRS). This study aimed to determine the overall HUS of CRS, the factors which influence the HUS, and the preferable method.

METHODS

A cross-sectional study was conducted. Patients with primary CRS were recruited. Clinical and socioeconomic data together with HUS were assessed. Four HUS scores determined from the four different methods were compared.

RESULTS

A total of 335 patients were enrolled. The overall HUS, as measured by EQ-5D-5L, VAS, TTO, and SG, was 0.88 ± 0.14, 0.79 ± 0.17, 0.89 ± 0.15, and 0.86 ± 0.16, respectively. The multivariable linear regression revealed that each increasing 22-item sinonasal outcome test (SNOT-22) score predicted a reduction of 0.002 to 0.003 in HUS (all methods, p < 0.01). Patients who scheduled for endoscopic sinus surgery had 0.06 to 0.11 HUS lower than other groups in EQ-5D-5L and VAS (all p < 0.05). Higher endoscopy score, age, presence of comorbid airway diseases, and lower education correlated with lower HUS (p < 0.05). Given the HUS results and regression models, the EQ-5D-5L is likely the preferable choice.

CONCLUSION

The overall HUS of CRS was approximately 0.79-0.89. High SNOT-22 score and those who failed medications, presence of comorbid AR/asthma, increased age, high endoscopy score, and low education negatively impacted HUS. Our data suggest that EQ-5D-5L is a preferable method for measuring HUS in patients with CRS.

Health care disparities and chronic rhinosinusitis: Does neighborhood disadvantage impact outcomes in sinonasal disease?

OBJECTIVE

Socioeconomic status (SES) is linked to health outcomes but has not been well studied in patients with chronic rhinosinusitis (CRS). The area deprivation index (ADI) is a comprehensive measure of geographic SES that ranks neighborhood disadvantage. This investigation used ADI to understand the impact of neighborhood disadvantage on CRS treatment outcomes.

METHODS

A total of 642 study participants with CRS were prospectively enrolled and self-selected endoscopic sinus surgery (ESS) or continued appropriate medical therapy as treatment. The 22-item SinoNasal Outcome Test (SNOT-22) and Medical Outcomes Study Questionnaire Short-Form 6-D (SF-6D) health utility value scores were recorded pre- and post-treatment. Using residence zip codes, national ADI scores were retrospectively assigned to patients. Spearman's correlation coefficients (Rs) and Cramer's V effect size (φc) with 95% confidence interval (CI) were calculated.

RESULTS

A history of ESS was associated with significantly worse ADI scores compared to no history of ESS (φc = 0.18; 95% CI: 0.10, 0.25; p < 0.001). Baseline total SNOT-22 (Rs = 0.14; 95% CI: 0.06, 0.22; p < 0.001) and SF-6D values (Rs = -0.20; 95% CI: -0.27, -0.12; p < 0.001) were significantly negatively correlated with national ADI rank. No significant correlations between ADI and within-subject improvement, or achievement of >1 minimal clinically important difference, in SNOT-22 or SF-6D scores after treatment were found.

CONCLUSIONS

Geographic socioeconomic deprivation was associated with worse baseline disease severity and history of prior surgical intervention. However, ADI did not correlate with improvement in disease-specific outcomes. The impact of socioeconomic deprivation on outcomes in CRS requires further investigation.

Health Utility Score in Thai Patients with Chronic Rhinosinusitis: Pre- and Postoperative Analyses

BACKGROUND

Endoscopic sinus surgery (ESS) can increase the health utility score (HUS) of patients with chronic rhinosinusitis (CRS) who require the surgery. HUS varies depending on the geographical or living environment. HUS in CRS has never been evaluated in Thailand. The objective of this study was to evaluate the HUS of Thai patients with CRS before and after ESS through multiple approaches.

METHODS

Thai patients (age ≥ 18) with CRS scheduled for ESS were enrolled in this prospective study. The preoperative (baseline) demographics, 22-items sinonasal outcome test, endoscopic score, and CT score were recorded. The HUS was evaluated using four methods: the EuroQoL-5 Dimension-5 level (EQ-5D-5L), Visual Analog Scale (VAS), Standard gamble (SG), and Time trade-off (TTO); at baseline, three months and six months post-operation.

RESULTS

Data from 60 patients were analyzed. The mean baseline HUS scores by EQ-5D-5L, VAS, SG, and TTO were 0.75, 0.65, 0.79, and 0.85, respectively. The postoperative HUS significantly improved to 0.96, 0.91, 0.96, 0.97 at three months, and 0.97, 0.92, 0.97, and 0.98 at six months, respectively. ESS raised the HUS by 0.12-0.27 points. Among the four methods, VAS showed the lowest HUS at all time points.

CONCLUSION

The preoperative HUS in Thai patients with CRS generally increased to near-perfect values after the ESS. The increase in HUS reflecting the improved general quality of life, was demonstrated at three and up to six months after ESS.

LEVEL OF EVIDENCE

4 Laryngoscope, 134:2070-2076, 2024.

Type 2 diabetes mellitus increases postoperative recurrence risk in Chinese patients with chronic rhinosinusitis

BACKGROUND

The effect of type 2 diabetes mellitus (T2DM) on postoperative recurrence of chronic sinusitis (CRS) is unclear.

OBJECTIVE

To investigate the association between T2DM and postoperative recurrence in CRS patients.

METHODS

CRS patients who underwent surgery in our hospital from January 2018 to April 2020 were included and followed up for three years. Patients were classified into non-recurrent and recurrent CRS groups based on follow-up outcome, and logistic regression analysis was performed to identify risk factors for postoperative recurrence.

RESULTS

A total of 412 CRS patients were included of whom 68 had T2DM. The postoperative recurrence rate was significantly higher in the T2DM group compared to the non-T2DM group (p < .05). T2DM prevalence and fasting blood glucose (FBG) levels were higher in recurrent CRS patients than those in non-recurrent CRS cases (p < .05). Multivariate regression analyses showed that age, duration of disease, FBG, and comorbid allergic rhinitis (AR) were significantly associated with an increased risk of postoperative recurrence of CRS (p < .05). Furthermore, adjusted logistic regression model revealed that T2DM was an independent risk factor for postoperative recurrence of CRS (p < .05).

CONCLUSIONS

Elevated FBG levels may significantly influenced the postoperative recurrence of CRS in Chinese patients, and T2DM was an independent risk factor for recurrence.

Work productivity and activity impairment in patients with chronic rhinosinusitis undergoing endoscopic sinus surgery-A prospective, multi-institutional study

BACKGROUND

Productivity loss and activity limitations due to chronic rhinosinusitis (CRS) are known to contribute to the significant economic and personal burden of disease. The purpose of this study was to assess productivity and activity impairment before and after endoscopic sinus surgery (ESS) for medically refractory CRS.

METHODS

This investigation was a prospective, multi-institutional, observational cohort study. Patients diagnosed with medically refractory CRS completed the Work Productivity and Activity Impairment-Specific Health Problem (WPAI-SHP) questionnaire before surgery and approximately 6 months after the procedure. Factors associated with minimal clinical important differences (MCIDs) for productivity and activity impairment were identified.

RESULTS

A total of 279 study participants were screened for inclusion, of whom 176 (63.1%) with postoperative follow-up were included in the final cohort. Preoperative productivity and activity impairment were observed in 63.2% and 69.8% of the patients, respectively. Among these patients, postoperative improvement equaling at least 1 MCID was reported in both productivity (76.1%) and activity (76.4%) impairments. Multivariate regression identified sphenoidotomy (odds ratio [OR], 4.18; 95% confidence interval [CI], 1.03-17.02) as the only factor associated with increased likelihood of productivity improvement, whereas septoplasty during ESS (OR, 8.45; 95% CI, 2.33-30.68) and migraine (OR, 0.35; 95% CI, 0.12-0.96) were associated with differential odds of activity improvement.

CONCLUSION

CRS is associated with a substantial burden on productivity and activity that significantly improves after treatment with ESS. These data may facilitate improved patient counseling and shared decision-making regarding surgical management for CRS.

Does food insecurity affect musculoskeletal symptoms, fatigue, and productivity of municipality cleaners? A cross-sectional study

BACKGROUND

Municipality cleaners are exposed to food insecurity, Musculoskeletal Symptoms (MSs), and fatigue.

OBJECTIVE

This study aimed to investigate the effect of food insecurity on MSs, fatigue, and productivity among municipality cleaners.

METHODS

This study was conducted on 399 Iranian male municipality cleaners with at least one year of working experience. The data were gathered via a demographic/occupational questionnaire, the Persian version of the Household Food Insecurity Access Scale (P-HFIAS), the Persian version of Nordic Musculoskeletal Questionnaire (P-NMQ), the Persian version of the Multidimensional Assessment of Fatigue scale (P-MAF), and the Persian version of Health and Work Questionnaire (P-HWQ). Data were analyzed using descriptive statistics, multiple logistic regression (Forward Wald), and multiple linear regression (Stepwise).

RESULTS

The findings revealed that 42.6%of the municipality cleaners were in the 'severely food insecure' category. The highest prevalence of MSs in the past week were related to knees (35.8%), lower back (35.1%), and ankles/feet (28.8%). Based on the results, the chance of MSs in the shoulders (OR = 1.66) and ankles/feet (1.60) regions, and MSs at least in one body region (OR = 1.47) was higher in the individuals with severe food insecurity than the others. Considering the P-MAF, food insecurity was associated with the 'degree and severity', 'distress that it causes', and 'timing of fatigue' subscales and 'total fatigue'. Considering the P-HWQ, food insecurity was associated with 'productivity', 'other's assessment', 'concentration/focus', 'supervisor relations', 'non-work satisfaction', and 'impatience/irritability' subscales.

CONCLUSION

The study revealed an association between food insecurity and MSs in some body regions and fatigue and productivity subscales among the municipality cleaners. Nutritional and ergonomic programs are recommended to reduce municipality cleaners' food insecurity, MSs, and fatigue and enhance their productivity.

Perceived Financial Insecurity Impacts Healthcare Decision-Making Among Patients With Sinusitis

OBJECTIVES/HYPOTHESIS

The economic burden of sinusitis is significant, and socioeconomic factors can impact patient decision-making. The purpose of this study was to examine the impact of perceived financial insecurity on healthcare decision-making and treatment compliance among sinusitis patients.

STUDY DESIGN

Cross-sectional study using the 2018 National Health Interview Survey.

METHODS

Survey responses to nine questions regarding financial stressors and nine questions regarding cost-saving healthcare actions were recorded, which included seeking lower cost medication, medication noncompliance, and avoiding care visits due to costs.

RESULTS

There was a total weighted sample size of 28.9 million patients who self-reported a diagnosis of sinusitis (12% of the U.S. population). Sinusitis patients who reported cost-saving actions had an increased severity of perceived financial insecurity than those without cost-saving actions (P < .001). Sinusitis patients with perceived financial insecurity had the highest odds of at least one cost-saving action (odds ratio [OR] = 5.94, 95% CI = 5.911-5.970, P < .001), followed by lack of health insurance (OR = 5.13, 95% CI = 5.107-5.159, P < .001), and poor self-reported health status (OR = 2.81, 95% CI = 2.792-2.822, P < .001). Increasing the number of financial stressors increased the odds of at least one cost-saving action (P < .001). Across all financial stressors, the most commonly performed cost-saving action was asking for lower cost medication.

CONCLUSIONS

Perceived financial insecurity is associated with cost-saving healthcare actions among sinusitis patients, including treatment noncompliance. Interventions to assess financial insecurity among sinusitis patients may facilitate shared decision-making for optimal, individualized treatment plans that may lead to improved outcomes and quality of life.

LEVEL OF EVIDENCE

NA. Laryngoscope, 2021.