Relationship between socioeconomic status, exposure to airborne pollutants, and chronic rhinosinusitis disease severity

Abstract

Background: Air pollution directly interacts with airway mucosa, yet little is known about how pollutants affect upper airway inflammation. Studies have shown increased incidence of chronic rhinosinusitis (CRS), rhinitis, and asthma in areas with higher traffic pollution, and these neighborhoods are often associated with lower socioeconomic status (SES). The Area Deprivation Index (ADI) assesses neighborhood-level SES by zip code. The purpose of this study was to assess the relationship between SES and exposure to inhaled pollutants and CRS disease severity.

Methods: CRS patients with and without nasal polyps (CRSwNP and CRSsNP, respectively) were identified (total patients = 234; CRSwNP patients = 138; CRSsNP patients = 96). Pollutant concentrations, including particulate matter 2.5 (PM_2.5 ), black carbon (BC), and nitrogen dioxide (NO₂ ), were measured at 70 sites within the defined countywide sites and used to estimate patient exposures. SES was measured by ADI state deciles. Disease severity metrics included the modified Lund-Mackay score (LMS), the need for systemic steroids, and functional endoscopic sinus surgery (FESS). Associations were analyzed and identified using linear, logistic, and Poisson multivariable regression.

Results: The distribution of CRSsNP and CRSwNP patients across ADI state deciles was similar. ADI, however, was a predictor of exposure to airborne pollutants (PM_2.5 , BC, and NO₂ ) with a 1.39%, 2.39%, and 2.49% increase in PM_2.5 , BC, and NO₂ per increasing decile increment (p < 0.0001), respectively, which demonstrated a direct correlation between deprived neighborhoods and higher levels of exposure to PM_2.5 , BC, and NO₂ with an increase in pollutant levels per increase in ADI decile. Furthermore, ADI was a predictor for increased steroid treatment.

Conclusion: Lower SES predicted higher exposure to air pollution and increased disease severity in patients with CRS as demonstrated by the increased need for steroid treatment.

Keywords: air pollutants; chronic rhinosinusitis; disadvantaged; environmental exposure; health inequalities; nasal polyps; nitrogen dioxide; particulate matter; risk factors; socioeconomic status.