Incidence and associated premorbid diagnoses of patients with chronic rhinosinusitis - 29/04/13
, Rakesh K. Chandra, MD a, Jonathan Pollak, MPP c, Atsushi Kato, PhD b, David B. Conley, MD a, Anju T. Peters, MD b, Leslie C. Grammer, MD b, Pedro C. Avila, MD b, Robert C. Kern, MD a, Walter F. Stewart, PhD, MPH d, Robert P. Schleimer, PhD b, Brian S. Schwartz, MD, MS c, d
Corresponding author: Bruce K. Tan, MD, Department of Otolaryngology Head and Neck Surgery, Northwestern University Feinberg School of Medicine, 676 N St Clair, Suite 1325, Chicago, IL 60611.Abstract |
Background |
Chronic rhinosinusitis (CRS) is a prevalent condition with underexplored risk factors.
Objectives |
We sought to determine CRS incidence and evaluate associations with a range of premorbid medical conditions for chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal polyps (CRSwNP) using real-world clinical practice data.
Methods |
Electronic health records data from 446,480 Geisinger Clinic primary care patients were used for a retrospective longitudinal cohort study for data from 2001-2010. By using logistic regression, newly diagnosed CRS cases between 2007 and 2009 were compared with frequency-matched control subjects on premorbid factors in the immediate (0-6 months), intermediate (7-24 months), and entire observed timeframes before diagnosis.
Results |
The average incidence of CRS was 83 ± 13 CRSwNP cases per 100,000 person-years and 1048 ± 78 CRSsNP cases per 100,000 person-years. Between 2007 and 2009, 595 patients with incident CRSwNP and 7523 patients with incident CRSsNP were identified and compared with 8118 control subjects. Compared with control subjects and patients with CRSsNP, patients with CRSwNP were older and more likely to be male. Before diagnosis, patients with CRS had a higher prevalence of acute rhinosinusitis, allergic rhinitis, chronic rhinitis, asthma, gastroesophageal reflux disease, adenotonsillitis, sleep apnea, anxiety, and headaches (all P < .001). Patients with CRSsNP had a higher premorbid prevalence of infections of the upper and lower airway, skin/soft tissue, and urinary tract (all P < .001). In the immediate and intermediate timeframes analyzed, patients with CRS had more outpatient encounters and antibiotic prescriptions (P < .001), but guideline-recommended diagnostic testing was performed in a minority of cases.
Conclusions |
Patients who are given a diagnosis of CRS have a higher premorbid prevalence of anxiety, headaches, gastroesophageal reflux disease, sleep apnea, and infections of the respiratory system and some nonrespiratory sites, which results in higher antibiotic, corticosteroid, and health care use. The use of guideline-recommended diagnostic testing for confirmation of CRS remains poor.
Le texte complet de cet article est disponible en PDF.Key words : Epidemiology, incidence, sinusitis, nasal polyps, risk factors, asthma, rhinitis, nested case-control study, antibiotics, diagnosis
Abbreviations used : CPT, CRS, CRSsNP, CRSwNP, CT, EHR, GERD, ICD-9, OR, URI, UTI
Plan
| Supported by National Institutes of Health grants K23DC012067 (to B.K.T.), R01 HL068546, R01 HL078860, and R01 AI072570, as well as the Ernest S. Bazley Trust (to R.P.S.). |
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| Disclosure of potential conflict of interest: B. K. Tan has been supported by one or more grants from the National Institutes of Health (NIH), has received one or more grants from or has one or more grants pending with the Triological Society, and has received one or more payments for travel/accommodations/meeting expenses from the Foundation for Innovation, Education, and Research in Otorhinolaryngology. J. Pollak is employed by Johns Hopkins Bloomberg School of Public Health. A. T. Peters has provided expert testimony regarding Stevens-Johnson syndrome and has received one or more payments for lecturing from or is on the speakers’ bureau for Baxter. R. P. Schleimer has been supported by one or more grants from the NIH and has consultancy arrangements with Intersect ENT, GlaxoSmithKline, and Allakos. B. S. Schwartz has been supported by one or more grants from Northwestern University. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 131 - N° 5
P. 1350-1360 - mai 2013 Retour au numéro
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