Racial, Ethnic Disparities Found in Patients with Chronic Rhinosinusitis Presenting for Surgery

Nasal polyps were more common in the nonwhite group than among whites, occurring in 59% of Asians, 42% of the African Americans, 63% of the other population, and only 37% of whites. The differences among the groups were statistically significant. Other conditions considered in the study included asthma, allergic rhinitis, prior surgeries, and smoking, but differences seen among the groups in these categories were not statistically significant.

Lund-Mackay CT scores and Lund-Kennedy endoscopy scores were both used to rate the severity of disease. The mean Lund-Mackay CT score was an average of two points higher (worse) in nonwhites than whites: In whites the score was 11.9, and in nonwhites it was 13.8. The difference was statistically significant. This was likely related to the more common presence of nasal polyposis, she said.

When it came to the Lund-Kennedy endoscopy scores, there were no differences in endoscopy scores across race groups, she said.

Researchers also used the Rhinosinusitis Disability Index, a disease-specific measure of quality of life. This was statistically worse in the nonwhite groups, across all three subscales [physical, functional, and emotional] and the total score, Dr. Litvack said. In contrast, there was no difference on the Chronic Sinusitis Survey for either subscale or total.

As for ethnicity, researchers focused on the small Hispanic-Latino portion of the study population. There were some significant differences seen, even though there were no differences in age, education, income, and clinical characteristics between them and the non-Hispanic-Latino patients. CT and endoscopy scores were not statistically different either. There was also no difference on the Chronic Sinusitis Survey with regard to either symptoms or medication use.

However, we found significantly worse disease-specific quality of life across all three subscales of the RSDI and the total score, she said.

In brief, the researchers saw a larger portion of nonwhite patients with nasal polyposis in the cohort. We also saw that nonwhite patients presented with worse disease severity on CT exam, although this is likely related to nasal polyposis. However, we found significantly worse disease-specific quality of life in both our race and ethnicity analyses. And this was not accounted for by other potential variables, Dr. Litvack said.

She noted that there were some limitations to the study, including the small number of some of the minority groups, and the limited breakdown by ethnicity. In addition, although the study design could show that disparities exist, it could not unravel the underlying causes.