title: Socioeconomic status: a disease modifier of chronic rhinosinusitis?
abstract: BACKGROUND
  The Lund-MacKay score (LMS) correlates poorly with chronic rhinosinusitis (CRS) symptom severity. Patients with CRS also tend to report relatively lower levels of mental wellbeing. Our purpose was to determine if there is a correlation between socio-economic status (SES) and CRS severity as measured by the LMS, and if there is an association between depression symptoms and the severity of CRS using the LMS.
  
  
  METHODS
  A total of 127 patients diagnosed with CRS were prospectively recruited and assessed with a sinonasal assessment questionnaire (SNAQ-11), and the Patient Health Questionnaire (PHQ-9) for depression. Each patient`s education level, family income, and smoking behavior were determined. The sinus CT scan was scored using the LMS. The data were analyzed using ordinary least squares (OLS) regression techniques.
  
  
  RESULTS
  Having a highschool education or less was associated with higher SNAQ-11 scores while being a daily smoker was associated with higher SNAQ-11 scores. There was no significant relationship between educational attainment, financial income or daily smoking and sinus CT score. Including depression scores in the SNAQ-11, regression equations indicated a significant and positive relationship between depression severity and SNAQ-11 score. CRS with polyps was negatively associated with SNAQ-11 scores but, as expected, it was positively associated with a higher LMS.
  
  
  CONCLUSIONS
  Lower SES status is a negative modifying factor of subjective CRS severity but it has no impact on the LMS. Depression symptoms are associated with increased subjective CRS severity but they have no effect on the LMS. How SES and depression impact on a patient`s self-reported disease severity requires further study.
authors: Department of Otolaryngology-Head and Neck Surgery, Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada. shaunkilty@hotmail.com
authors: Shaun J
authors: SJ
authors: Kilty
authors: J Ted
authors: JT
authors: McDonald
authors: Stephanie
authors: S
authors: Johnson
authors: Dakhellallah
authors: D
authors: Al-Mutairi
mesh_terms: D002908:Chronic Disease; D003863:Depression / Q000453:epidemiology; D004522:Educational Status; D006801:Humans; D007182:Income; D016018:Least-Squares Analysis; D011446:Prospective Studies; D012220:Rhinitis / Q000453:epidemiology; D012720:Severity of Illness Index; D012852:Sinusitis / Q000453:epidemiology; D012923:Social Class