Socioeconomic and Demographic Influences on Biologic Treatment Outcomes in Patients With Chronic Rhinosinusitis.

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.