社会人口学状况和性别对囊性纤维化患者慢性鼻窦炎和嗅觉的影响。
Impact of sociodemographic status and sex on chronic rhinosinusitis and olfaction in people with cystic fibrosis.
作者信息
Han Ethan J, Liu Christine M, Fischer Jakob L, Mace Jess C, Markarian Karolin, Alt Jeremiah A, Bodner Todd E, Chowdhury Naweed I, Eshaghian Patricia H, Gao Yuqing A, Getz Anne E, Hwang Peter H, Khanwalkar Ashoke, Kimple Adam J, Lee Jivianne T, Li Douglas A, Norris Meghan, Nayak Jayakar V, Owens Cameran, Patel Zara M, Poch Katie, Schlosser Rodney J, Smith Kristine A, Smith Timothy L, Soler Zachary M, Suh Jeffrey D, Turner Grant A, Wang Marilene B, Taylor-Cousar Jennifer L, Saavedra Milene T, Beswick Daniel M
机构信息
Department of Head and Neck Surgery, University of California, Los Angeles, California, USA.
Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland, Oregon, USA.
出版信息
Int Forum Allergy Rhinol. 2024 Nov;14(11):1700-1713. doi: 10.1002/alr.23402. Epub 2024 Jul 5.
BACKGROUND
Sociodemographic status (SDS) including race/ethnicity and socioeconomic status as approximated by education, income, and insurance status impact pulmonary disease in people with cystic fibrosis (PwCF). The relationship between SDS and chronic rhinosinusitis (CRS) remains understudied.
METHODS
In a prospective, multi-institutional study, adult PwCF completed the 22-Question SinoNasal Outcome Test (SNOT-22), Smell Identification Test (SIT), Questionnaire of Olfactory Disorder Negative Statements (QOD-NS), and Cystic Fibrosis Questionnaire-Revised (CFQ-R). Lund-Kennedy scores, sinus computed tomography, and clinical data were collected. Data were analyzed across race/ethnicity, sex, and socioeconomic factors using multivariate regression.
RESULTS
Seventy-three PwCF participated with a mean age of 34.7 ± 10.9 years and 49 (67.1%) were female. Linear regression identified that elexacaftor/tezacaftor/ivacaftor (ETI) use (β = ‒4.09, 95% confidence interval [CI] [‒6.08, ‒2.11], p < 0.001), female sex (β = ‒2.14, 95% CI [‒4.11, ‒0.17], p = 0.034), and increasing age (β = ‒0.14, 95% CI [‒0.22, ‒0.05], p = 0.003) were associated with lower/better endoscopy scores. Private health insurance (β = 17.76, 95% CI [5.20, 30.32], p = 0.006) and >16 educational years (β = 13.50, 95% CI [2.21, 24.80], p = 0.020) were associated with higher baseline percent predicted forced expiratory volume in one second (ppFEV). Medicaid/Medicare insurance was associated with worse endoscopy scores, CFQ-R respiratory scores, and ppFEV (all p < 0.017), and Hispanic/Latino ethnicity was associated with worse SNOT-22 scores (p = 0.047), prior to adjustment for other cofactors. No other SDS factors were associated with SNOT-22, QOD-NS, or SIT scores.
CONCLUSIONS
Differences in objective measures of CRS severity exist among PwCF related to sex, age, and ETI use. Variant status and race did not influence patient-reported CRS severity measures or olfaction in this study. Understanding how these factors impact response to treatment may improve care disparities among PwCF.
CLINICAL TRIALS
NCT04469439.
背景
社会人口统计学状况（SDS），包括种族/族裔以及由教育程度、收入和保险状况近似衡量的社会经济地位，会影响囊性纤维化患者（PwCF）的肺部疾病。SDS与慢性鼻-鼻窦炎（CRS）之间的关系仍未得到充分研究。
方法
在一项前瞻性、多机构研究中，成年PwCF完成了22题鼻-鼻窦结局测试（SNOT-22）、嗅觉识别测试（SIT）、嗅觉障碍否定陈述问卷（QOD-NS）以及囊性纤维化修订问卷（CFQ-R）。收集了Lund-Kennedy评分、鼻窦计算机断层扫描和临床数据。使用多变量回归对种族/族裔、性别和社会经济因素的数据进行了分析。
结果
73名PwCF参与了研究，平均年龄为34.7±10.9岁，49名（67.1%）为女性。线性回归确定，使用依列卡福/替扎卡福/依伐卡福（ETI）（β = -4.09，95%置信区间[CI][-6.08，-2.11]，p < 0.001）、女性（β = -2.14，95% CI [-4.11，-0.17]，p = 0.034）以及年龄增长（β = -0.14，95% CI [-0.22，-0.0]，p = 0.003）与更低/更好的内镜检查评分相关。私人健康保险（β = 17.76，95% CI [5.20，30.32]，p = 0.006）和教育年限>16年（β = 13.50，95% CI [2.21，24.80]，p = 0.020）与更高的基线一秒用力呼气量预测百分比（ppFEV）相关。医疗补助/医疗保险与更差的内镜检查评分、CFQ-R呼吸评分和ppFEV相关（所有p < 0.017），在对其他协变量进行调整之前，西班牙裔/拉丁裔与更差的SNOT-22评分相关（p = 0.047）。没有其他SDS因素与SNOT-22、QOD-NS或SIT评分相关。
结论
PwCF中CRS严重程度的客观测量指标在性别、年龄和ETI使用方面存在差异。在本研究中，基因变异状态和种族并未影响患者报告的CRS严重程度测量指标或嗅觉。了解这些因素如何影响治疗反应可能会改善PwCF之间的护理差异。
临床试验
NCT04469439。
Zotero 插件