Socioeconomic and Demographic Influences on Biologic Treatment Outcomes in Patients With Chronic Rhinosinusitis
Ameen Biadsee, Firas Kassem, Itamar Shenfeld, Ori Cohen Michael, Dafna Gernshbel-Milk, Tomer BoldesImportance:
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,
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.