Markers of disease severity and socioeconomic factors in allergic fungal rhinosinusitis.
BACKGROUND
Allergic fungal rhinosinusitis (AFRS) is a refractory subtype of chronic rhinosinusitis. There is a paucity of data investigating the association of epidemiologic markers of disease severity. The primary objective of this study is to evaluate components of disease severity with socioeconomic status and health care access.


METHODS
A retrospective analysis was performed on patients diagnosed with AFRS by Bent and Kuhn criteria from 2000 to 2013. Severity of disease was measured by orbitocranial involvement, bone erosion, Lund-Mackay score, serum immunoglobulin E (IgE), and mold hypersensitivity. The North Carolina State Data Center provided county-specific socioeconomic and demographic data. Fisher's exact test, Wilcoxon rank sum test, Pearson correlations, and multivariable linear regression models were used to explore associations between variables.


RESULTS
Of 93 patients, 58% were African American and 39% Caucasian with a male:female ratio of 1.4:1 and average age at presentation of 29 years. Race, age, insurance status, and gender were not associated with severity of disease. Bone erosion was correlated with residence in counties with lower income per capita (p = 0.01). Patients with orbitocranial involvement resided in more rural counties (p = 0.01) with less primary care providers per capita (p = 0.02). Residence in counties with older or poorer quality housing was associated with a higher prevalence of bone erosion (p = 0.02).


CONCLUSIONS
Within our cohort of patients residing in North Carolina, markers of disease severity (bone erosion and orbitocranial involvement) in AFRS were associated with lower income, rural counties, poor housing quality, and less health care access.
Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, NC.
Justin D
JD
Miller
Allison M
AM
Deal
Kibwei A
KA
McKinney
Stanley W
SW
McClurg
Kenneth D
KD
Rodriguez
Brian D
BD
Thorp
Brent A
BA
Senior
Adam M
AM
Zanation
Charles S
CS
Ebert
D000293:Adolescent; D000328:Adult; D000368:Aged; D001842:Bone and Bones / Q000473:pathology; D002648:Child; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D009657:North Carolina / Q000453:epidemiology; D065631:Rhinitis, Allergic; D012221:Rhinitis, Allergic, Perennial / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D012424:Rural Population; D012720:Severity of Illness Index; D012852:Sinusitis / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D012959:Socioeconomic Factors; D055815:Young Adult
D007073:Immunoglobulin E
allergy; bone; chronic rhinosinusitis; demography; epidemiology; gender; mold; race; sinusitis