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Chronic rhinosinusitis and its comorbidities: a nationwide, population-based cohort study

Published online: September 18, 2019

Chronic rhinosinusitis (CRS) is defined as an inflammatory condition involving the paranasal sinuses and linings of the nasal passages that persist for ≥12 weeks. It is a common chronic disease characterized by 2 or more symptoms, 1 of which should be a nasal blockage or nasal discharge and/or facial pain or pressure and/or reduction or loss of smell. Additionally, this chronic inflammatory status subsequently could result in potential physiological and psychological stresses. For this reason, CRS patients usually experience certain comorbidities. Among those, the best-known comorbidity related to CRS is asthma. Besides asthma, other comorbidities also associated with CRS are bronchiectasis and chronic obstructive pulmonary disease. However, there have been few population-based, long-term cohort studies that investigated the relationship between CRS and its comorbidities.

In a recent issue of The Journal of Allergy and Clinical Immunology: In Practice, Kim JY et al examine the potential relationship between CRS and its comorbidities, including asthma, acute myocardial infarction (AMI), stroke, anxiety disorder, and depression. This study used National Sample Cohort (NSC) data from the Korea National Health Insurance Service (KNHIS) from 2002‒2013, including 14,762 patients with CRS and 29,524 without CRS who were propensity score-matched by sociodemographic factors and enrollment year. The database of KNHIS-NSC 2002–2013 is comprised of 1,025,340 nationally representative subjects, accounting for approximately 2.2% of the South Korean population in 2002. Stratified random sampling was performed using 1,476 strata, by age (18 groups), sex (2 groups), and income level (41 groups: 40 health insurance beneficiaries and one medical aid) among the South Korean population of 46 million in 2002. This study performed the 1:2 propensity score matching using the nearest neighbor matching method and sociodemographic factors and enrollment year. The incidence rates per 1,000 person-years for specific diseases (asthma, AMI, stroke, anxiety disorder, and depression) were obtained by dividing the number of patients with incidents of specific diseases by person-years at risk. For identifying whether CRS increased the risk of occurrence of specific diseases, Cox proportional hazards models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for the other predictor variables.

The incidence of asthma, AMI, and stroke were 71.1, 3.1, and 7.7 per 1000 person-years in CRS patients. After adjustment for other sociodemographic factors, CRS patients developed asthma, AMI, and stroke more frequently than those in the non-CRS patients, the adjusted HRs of 2.04 (95% CI 1.98-2.1) in asthma, 1.26 (95% CI, 1.12-1.41) in AMI, and 1.18 (95% CI, 1.1-1.27) in stroke, respectively. Moreover, in the aspect of mental health, the incidence of anxiety disorder and depression in CRS patients was 42.1 and 24.2 per 1000 person-years. The adjusted HR of 1.56 (95% CI, 1.51-1.61) for anxiety disorder and 1.52 (95% CI, 1.45-1.59) for depression were significantly greater in CRS patients, compared to non-CRS patients. Thus, this observational study using nationwide data suggests that CRS is associated with an increased incidence of asthma, AMI, stroke, anxiety disorder, and depression. Therefore, clinicians should carefully monitor CRS patients and take specific precautions to reduce their risk of developing asthma, AMI, stroke, anxiety disorder, and depression.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

Graphical Abstract

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