TY - JOUR
T1 - Socioeconomic status impacts postoperative productivity loss and health utility changes in refractory chronic rhinosinusitis
AU - Beswick, Daniel M.
AU - Mace, Jess C.
AU - Soler, Zachary M.
AU - Rudmik, Luke
AU - Alt, Jeremiah A.
AU - Smith, Kristine A.
AU - Detwiller, Kara Y.
AU - Ramakrishnan, Vijay R.
AU - Smith, Timothy L.
N1 - Funding Information:
Potential conflicts of interest: T.L.S., J.C.M., V.R.R, and Z.M.S. were supported for this investigation by a grant from the National Institute on Deafness and Other Communication Disorders (NIDCD), one of the National Institutes of Health, Bethesda, MD., USA (R01 DC005805; Co-PI: T.L.S./Z.M.S.). This funding organization did not contribute to the design or conduct of this study; preparation, review, approval, or decision to submit this manuscript for publication. Z.M.S. is a consultant for Olympus (Central Valley, PA), Regeneron, Novartis, Sinusonic, and Optinose, none of which are affiliated with this investigation. There are no relevant financial disclosures for D.M.B., L.R., K.A.S., or K.Y.D. Presented orally to the ARS Summer Sinus Symposium, at Rhinoworld Chicago, on June 5-9, 2019, in Chicago, IL. Public clinical trial registration: http://clinicaltrials.gov/show/NCT02720653. Determinants of Olfactory Dysfunction in Chronic Rhinosinusitis.
Publisher Copyright:
© 2019 ARS-AAOA, LLC
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Background: Social determinants of health can have a substantial impact on treatment outcomes. Prior study has shown that socioeconomic status influences the likelihood of improvement in quality-of-life (QOL) following endoscopic sinus surgery (ESS). However, the impact of socioeconomic factors on changes in productivity loss and health utility after ESS remains unknown. Methods: Adult patients (≥18 years of age) with chronic rhinosinusitis (CRS) who underwent ESS were prospectively enrolled into a multi-institutional cohort study. Productivity losses were calculated using the human capital approach and monetized using U.S. government–estimated wage rates. Health utility values (HUVs) were derived from the Medical Outcomes Study Short-Form-12 survey using University of Sheffield algorithms. Independent socioeconomic factors of interest included: age, gender, ethnicity, insurance status, educational attainment, and household income categorized via the Thompson-Hickey model. Results: A total of 229 patients met inclusion criteria, and 163 (71%) provided postoperative follow-up. All subjects reported significant, within-subject improvement in both mean monetized productivity loss (p < 0.001) and HUV postoperatively (p < 0.001). Using paired sample statistics, patients with lowest income (≤$25,000/year) and with Medicare insurance did not report significant improvement in productivity loss (p ≥ 0.112) or HUV (p ≥ 0.081), although sample size limitations may have contributed to this finding. Patients in higher income tiers ($25,001 to $100,000/year and $100,001+/year) and those with employer-provided/private health insurance reported significant postoperative improvements in productivity loss and HUV (all p ≤ 0.003). Conclusion: Socioeconomic factors, including income and insurance provision, may impact improvements in productivity loss and HUV following ESS. Further research to validate these findings, ascertain mechanisms behind these results, and improve these outcomes is warranted.
AB - Background: Social determinants of health can have a substantial impact on treatment outcomes. Prior study has shown that socioeconomic status influences the likelihood of improvement in quality-of-life (QOL) following endoscopic sinus surgery (ESS). However, the impact of socioeconomic factors on changes in productivity loss and health utility after ESS remains unknown. Methods: Adult patients (≥18 years of age) with chronic rhinosinusitis (CRS) who underwent ESS were prospectively enrolled into a multi-institutional cohort study. Productivity losses were calculated using the human capital approach and monetized using U.S. government–estimated wage rates. Health utility values (HUVs) were derived from the Medical Outcomes Study Short-Form-12 survey using University of Sheffield algorithms. Independent socioeconomic factors of interest included: age, gender, ethnicity, insurance status, educational attainment, and household income categorized via the Thompson-Hickey model. Results: A total of 229 patients met inclusion criteria, and 163 (71%) provided postoperative follow-up. All subjects reported significant, within-subject improvement in both mean monetized productivity loss (p < 0.001) and HUV postoperatively (p < 0.001). Using paired sample statistics, patients with lowest income (≤$25,000/year) and with Medicare insurance did not report significant improvement in productivity loss (p ≥ 0.112) or HUV (p ≥ 0.081), although sample size limitations may have contributed to this finding. Patients in higher income tiers ($25,001 to $100,000/year and $100,001+/year) and those with employer-provided/private health insurance reported significant postoperative improvements in productivity loss and HUV (all p ≤ 0.003). Conclusion: Socioeconomic factors, including income and insurance provision, may impact improvements in productivity loss and HUV following ESS. Further research to validate these findings, ascertain mechanisms behind these results, and improve these outcomes is warranted.
KW - chronic disease
KW - endoscopic sinus surgery
KW - evidence-based medicine
KW - outcome assessment (health care)
KW - patient reported outcome measure
KW - quality of life
KW - sinusitis
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U2 - 10.1002/alr.22374
DO - 10.1002/alr.22374
M3 - Article
C2 - 31246360
AN - SCOPUS:85068174670
SN - 2042-6976
VL - 9
SP - 1000
EP - 1009
JO - International Forum of Allergy and Rhinology
JF - International Forum of Allergy and Rhinology
IS - 9
ER -