社会经济和人口统计学因素对慢性鼻窦炎患者生物治疗结果的影响
Socioeconomic and Demographic Influences on Biologic Treatment Outcomes in Patients With Chronic Rhinosinusitis.
文献信息
| PMID | 42813245 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Ameen Biadsee |
| 作者单位 | Department of Otolaryngology-Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel. |
| 期刊 | Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale |
| SCI 分区 | Q1 |
| IF | 2.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
重要性： 伴鼻息肉的慢性鼻窦炎（CRSwNP）是一种常见的炎症性疾病，显著损害生活质量（QOL）并造成巨大的经济负担。社会经济和人口统计学因素影响医疗可及性、治疗依从性和结局，但其对生物治疗反应的影响仍不明确。
目的： 探讨社会经济和人口统计学决定因素对CRSwNP单克隆抗体治疗前后症状严重程度和QOL的影响。
设计： 探索性回顾性队列研究，前瞻性收集社会经济和人口统计学数据。
场所： 三级医疗中心。
参与者： 2020年1月至2024年1月期间接受过内镜鼻窦手术并完成16周单克隆抗体治疗方案的顽固性CRSwNP成人。干预或暴露：评估的主要暴露为社会经济地位（SES；包括家庭收入）和人口统计学决定因素。
主要结局指标： 基线和治疗后（16周）随访的22项鼻窦结局测试（SNOT-22）和Meltzer分级评估。
结果： 共纳入40例患者（21例男性和19例女性；平均年龄50.4±12.1岁）。平均基线SNOT-22评分为69.0±15.8，Meltzer评分中位数为3（四分位距[IQR]：2-3.75）。在16周随访时，这些评分分别改善至33.8±20.5和1（IQR：0-2）。低收入患者（年收入<40 000美元）的基线SNOT-22评分比中等收入（年收入40 001-80 000美元）和高收入患者（年收入>80 000美元）更差（分别为79.4 vs 68.6 vs 57.1，P<.01），但显示出最大的绝对分数下降（ΔSNOT-22，分别为47.8 vs 34.7 vs 20.8，P=.01）。低收入患者在生物治疗后显示出最大的绝对改善（P=.01）；然而，对基线评分进行协变量调整后，所有收入层级显示出相似的比例效应。
结论： 收入较低的患者表现出更高的基线疾病严重程度。然而，生物治疗在所有SES层级中均产生了有意义的QOL绝对改善。
相关性： 认识到社会经济因素可能有助于优化CRS中的生物治疗。需要未来的多中心研究来验证这些差异并优化干预策略。
英文摘要
IMPORTANCE: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a prevalent inflammatory disease that significantly impairs quality of life (QOL) and imposes a substantial economic burden. Socioeconomic and demographic factors influence access to care, treatment adherence, and outcomes, yet their impact on response to biologic therapy remains poorly defined.
OBJECTIVE: To examine the impact of socioeconomic and demographic determinants on symptom severity and QOL before and after monoclonal antibody therapy for CRSwNP.
DESIGN: Exploratory retrospective cohort study with prospective socioeconomic and demographic data curation.
SETTING: Tertiary medical center.
PARTICIPANTS: Adults with recalcitrant CRSwNP from January 2020 to January 2024 who had undergone endoscopic sinus surgery and completed a 16-week regimen of monoclonal antibody therapy.Intervention or Exposures:The primary exposures evaluated were socioeconomic status (SES; including household income) and demographic determinants.
MAIN OUTCOME MEASURES: Baseline and post-treatment (16 weeks) follow-up of 22-item Sino-Nasal Outcome Test (SNOT-22) and Meltzer grading evaluation.
RESULTS: Forty patients (21 males and 19 females; mean age 50.4 ± 12.1) were included. The mean baseline SNOT-22 score was 69.0 ± 15.8, and the median Meltzer score was 3 (interquartile range [IQR]: 2-3.75). At 16-week follow-up, these scores improved to 33.8 ± 20.5 and 1 (IQR: 0-2), respectively. Low-income patients (<40 000 United States Dollar [USD] yearly) had worse baseline SNOT-22 scores compared to medium (40 001-80 000 USD yearly) and high-income patients (>80 000 USD yearly; 79.4 vs 68.6 vs 57.1, respectively, P < .01) but showed the largest absolute point reduction (ΔSNOT-22, 47.8 vs 34.7 vs 20.8, respectively, P = .01). Low-income patients showed the largest absolute improvement after biologic treatment (P = .01); however, covariate adjustment for baseline scores showed similar proportional effects across all income tiers.
CONCLUSIONS: Patients with lower incomes exhibited higher baseline disease severity. However, biologic treatment yielded meaningful absolute improvement in QOL across all SES tiers.
RELEVANCE: Recognizing socioeconomic factors may help optimize biologic therapy in CRS. Future multi-center research is needed to validate these disparities and optimize intervention strategies.