Regional variations in chronic rhinosinusitis, 2003-2006
Received 10 March 2009; received in revised form 7 May 2009; accepted 18 May 2009.
Abstract
Objectives
1. Characterize patient visits for chronic rhinosinusitis on the basis of age, gender, race, diagnostic services, and medication use. 2. Evaluate regional differences in patient visits for chronic rhinosinusitis.
Study Design
Analysis of cross-sectional survey data from two national databases of ambulatory medical encounters.
Setting
Not applicable.
Subjects and Methods
Four years (2003-2006) of data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey were analyzed. Visits involving chronic rhinosinusitis were identified by using reported diagnostic codes from the International Classification of Diseases, Ninth Revision. They were weighted to provide national estimates of care. Data were analyzed with the Pearson χ2 test using the SPSS 16.2 Complex Samples Module, taking into account the complex survey design and multiple time periods.
Results
A total of 4617 patient visits for chronic rhinosinusitis were identified, accounting for 1.95 percent of all visits. With the application of weights to this sample, these visits represent 91.2 million national visits. A significantly higher proportion of visits in the South involved African Americans (Pearson χ2 = 69.5, F = 6.7, df = 2.8, 2118, P < 0.01). Significantly fewer diagnostic services were provided or ordered in the Northeast (Pearson χ2 = 64.8, F = 4.0, df = 4.3, 3247, P < 0.01). Providers in the Northeast were also significantly less likely to order or renew more than three medications at the visit (Pearson χ2 = 54.0, F = 3.1, df = 2.6, 1930, P < 0.05). No regional differences were seen for age, gender, or setting type.
Conclusion
Significant regional variations exist for chronic rhinosinusitis in patient demographics, diagnosis, and management. Continuing research is needed to refine physician awareness, evaluation, and treatment of this disorder.
aDepartment of Surgery, Division of Otolaryngology–Head and Neck Surgery and Continuing Medical Education, University of California, San Diego School of Medicine, San Diego, CA
Corresponding author: Wendy M. Smith, MD, Resident Physician, Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of California, San Diego, 200 West Arbor Dr, Mail Code 8895, San Diego, CA 92103-8895
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
ABSTRACT