Sex differences in healthcare utilization for chronic rhinosinusitis: a prospective cohort study

An understanding of future healthcare needs of patients with chronic rhinosinusitis (CRS) is essential for patients and providers to make informed treatment decisions. Data on the predictors of long-term CRS-related healthcare utilization are limited. While there is evidence of sex differences in CRS, it is unknown whether the factors associated with long-term healthcare needs differ by sex.

The objectives of this study were to evaluate associations between CRS symptoms and CRS-related healthcare utilization and how these associations differ by sex.

We conducted a prospective study of 7,847 subjects, utilizing questionnaire and electronic health record data to assess CRS-related healthcare utilization. Individuals who met CRS symptom criteria were categorized into one of four symptom profiles in 2014: obstruction and discharge; pain or pressure without smell loss; smell loss without pain or pressure; and pain or pressure and smell loss. Healthcare utilization (2014-2019) was classified into one of six categories based on CRS-related clinical encounters and diagnostic imaging: minimal overall utilization, no CRS-related utilization; one-year of CRS-related utilization; repeated CRS-related utilization; episodic CRS-related utilization; and discontinued utilization. We evaluated associations between symptom profiles and utilization categories using multinomial logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI), assessing effect modification by sex using cross-product terms.

Of the 7,847 subjects, 62.7% were women and 37.3% were men. Among women, there was no association between CRS symptoms in 2014 and repeated CRS-related healthcare utilization (versus discontinued CRS-related utilization), whereas men with CRS symptoms had nearly twice the odds (OR 1.81 CI: 1.02, 3.20) of repeated utilization. Women who had CRS with pain and pressure, had higher odds of discontinued CRS-related utilization. This was not observed for other symptom profiles.

Healthcare utilization patterns for CRS varied by symptoms and sex. Women with facial pain/pressure were uniquely at risk for discontinuation of CRS-related care, providing further evidence of sex differences among individuals reporting sinonasal symptoms.