TOPLINE: 

Female sex is associated with up to 44% increased odds of chronic rhinosinusitis without nasal polyps (CRSsNP), but 37% reduced odds of chronic rhinosinusitis with nasal polyps (CRSwNP), with lower levels of type 2 inflammatory markers.

METHODOLOGY:

• Analysis included data from the All of Us Research Program, a nationwide dataset of US adults collected from academic medical centers, Veterans Affairs facilities, and community health centers from May 2018 to October 2023.
• A total of 258,245 participants were included in the final analysis, with 61.6% female and 38.4% male participants, where most (57.3%) were 50 years or older.
• Researchers examined chronic rhinosinusitis (CRS) diagnoses using Systematized Nomenclature of Medicine and International Classification of Diseases codes, stratifying into CRS with nasal polyps and CRS without nasal polyps.
• Primary exposure was participant sex, while covariates included demographics, socioeconomic status, risk factors, and comorbidities such as asthma and gastroesophageal reflux disease.

TAKEAWAY:

• Female participants younger than 60 years showed higher odds of CRSsNP (odds ratio [OR], 1.44; confidence interval with Holm-Bonferroni correction [CIH-B], 1.35-1.54) compared to male participants.
• Female sex was associated with lower odds of CRSwNP (OR, 0.63; CIH-B, 0.52-0.76) and lower serum eosinophils (β, −0.35; CIH-B, −0.44 to −0.25) and IgE (β, −99.73; CIH-B, −190.49 to −8.96) levels.
• Among participants aged 60 years or older, researchers found a negative interaction effect between female sex and CRSsNP (OR, 0.91; CIH-B, 0.84-0.99), indicating a weaker association.
• Analysis revealed a downward trend in CRSsNP prevalence among female participants aged 60 years or older, despite showing upward trends in younger age groups.

IN PRACTICE:

"A better understanding of biological sex-based differences in the development of CRS would enable better therapeutic strategies and public health approaches to address this condition," wrote the authors of the study.

SOURCE:

The study was led by Richard G. Chiu, BS, Department of Otolaryngology, College of Medicine, University of Illinois in Chicago. It was published online on October 23 in JAMA Otolaryngology-Head & Neck Surgery.

LIMITATIONS:

According to the authors, the cross-sectional nature of the study prevented establishing causation. The dataset showed sex imbalance with approximately 63% female participants, though this might be attributed to women being more engaged in survey-based research. The researchers note that CRS diagnoses were derived from historical medical records without verification through CT or endoscopy, allowing for potential over- or underdiagnosis. Additionally, the prevalence of CRSwNP was lower than suggested by existing literature, potentially indicating underreporting or underdiagnosis among study participants.

DISCLOSURES:

Sharmilee M. Nyenhuis, MD, disclosed receiving grants from the National Institutes of Health and the Asthma and Allergy Foundation of America, royalties from Wolters-Kluwer and Springer, and advisory board fees from GlaxoSmithKline outside the submitted work. Victoria S. Lee, MD, reported receiving grants from the National Institutes of Health during the study, consulting fees from Stryker, Aerin Medical, Regeneron Pharmaceuticals, and Sanofi US, and serving on the medical advisory board of Synopsys Surgical outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.