Socioeconomic Factors in Allergic Fungal Rhinosinusitis with Bone Erosion

SAN DIEGO-To date, various studies have demonstrated an increase in the incidence of orbital and skull base erosion in African Americans and males diagnosed with allergic fungal rhinosinusitis (AFRS), but other factors have yet to be delineated.

Noting that underlying reasons for the advanced presentation of AFRS in certain ethic and gender groups are unknown, researchers at the Medical University of South Carolina (MUSC) and the Department of Family and Preventive Medicine at the University of California, San Diego decided to evaluate several socioeconomic and demographic factors for their possible contribution to advanced presentations of AFRS. What they determined was that socioeconomic and geographic factors did not play a role in bone erosion, but that males with AFRS demonstrated a higher incidence of bone erosion.

Their study was presented by Mark D. Ghegan, MD, a resident in the MUSC Department of Otolaryngology-Head and Neck Surgery, on April 26 during the American Rhinologic Society’s program of the Combined Otolaryngology Spring Meeting.

Dr. Ghegan said the researchers’ hypothesis going into the study was that AFRS patients presenting with more extensive disease, i.e. bone erosion, would reside in areas with lower education levels, have lower mean income and less access to healthcare, and reside in coastal counties. The study design was a retrospective review of 54 patients diagnosed with AFRS, who were stratified by the presence or absence of radiologically identified bone erosion. In addition, the individuals were divided by South Carolina county with data from the Department of Defense.

Racial and Socioeconomic Factors Investigated

The researchers found that 77% of male patients had bone erosion and 70% of the patients were African American. However, they also found that only 18% of the patients with bone erosion were below the poverty level and 19% without bone erosion were below the poverty level. Forty percent of the patients with bone erosion lived in a coastal area and 33% without bone erosion also lived in a coastal area. The median incomes of those with and without bone erosion were almost identical.

The team, which also included Drs. Sarah K. Wise, Edward Gorham, and Rodney J. Schlosser, concluded that males with AFRS showed a significantly higher incidence of bone erosion, but there was no significant difference in bone erosion for race (63% of the total sample was African American), age, geographic region in South Carolina, insurance status (as a marker of economic status), and county socioeconomic factors.