Regional variations in chronic rhinosinusitis, 2003-2006

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 chi(2) 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 chi(2) = 69.5, F = 6.7, df = 2.8, 2118, P < 0.01). Significantly fewer diagnostic services were provided or ordered in the Northeast (Pearson chi(2) = 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 (Peat-son chi(2) = 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. (C) 2009 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.