Disparities in access to health care in adults with sinusitis in the United States

Jay P Shah; Gun Min Youn; Eric X Wei; Zara M Patel

doi:10.1002/alr.23167

Disparities in access to health care in adults with sinusitis in the United States

Int Forum Allergy Rhinol. 2023 Nov;13(11):2018-2029. doi: 10.1002/alr.23167. Epub 2023 Apr 25.

Authors

Jay P Shah^{1

2}, Gun Min Youn^{1

2}, Eric X Wei², Zara M Patel²

Affiliations

¹ Stanford University School of Medicine, Stanford, California, USA.
² Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, USA.

PMID: 37029607
DOI: 10.1002/alr.23167

Abstract

Background: Sinusitis can significantly decrease quality of life, is costly in both health care expenditure and lost productivity, and can lead to complications if treatment is delayed. Our objective was to explore disparities in health care access among adults with sinusitis based on sociodemographic factors.

Methods: A total of 32,994 participants (representing 244,838,261 US adults) who completed the 2016 National Health Interview Survey (NHIS) were analyzed, of whom 12.17% were diagnosed with sinusitis at least once in the prior 12 months. Multivariate regression analyses were performed.

Results: In regression analyses, female sex (odds ratio [OR], 2.00 [95% confidence interval (CI), 1.79-2.24]; p < 0.001) and older age groups were associated with increased odds of having sinusitis. Within the sinusitis cohort, Asian race (OR, 5.97 [95% CI, 1.61-22.12]; p = 0.008) and Hispanic ethnicity (OR, 6.97 [95% CI, 3.22-15.06]; p < 0.001) were associated with increased odds of obtaining foreign medications. Individuals with Medicaid had decreased odds of delaying care (OR, 0.37 [95% CI, 0.25-0.56]; p < 0.001) or not receiving care due to cost (OR, 0.40 [95% CI, 0.24-0.65]; p < 0.001), but increased odds of delaying care due to transportation barriers (OR, 4.64 [95% CI, 2.52-8.55]; p < 0.001). Uninsured individuals had higher odds for delaying care (OR, 4.97 [95% CI, 3.35-7.38]; p < 0.001) and not receiving care (OR, 5.46 [95% CI, 3.56-8.38]; p < 0.001) due to cost. Income >$100,000 was associated with a nearly 90% reduction in inability to obtain care due to cost (OR, 0.11 [95% CI, 0.05-0.21]; p < 0.001) and an over 99% reduction in inability to obtain care due to transportation issues compared with income < $35,000 (OR, 0.01 [95% CI, 0.00-0.04]; p< 0.001).

Conclusion: Significant disparities in health care access based on race, health insurance status, and income exist among adults with sinusitis in the United States.

Keywords: acute sinusitis; adult sinusitis; chronic rhinosinusitis; health care access; health disparities; racial disparities; sinusitis; socioeconomic disparities.