CRS Epidemiology Using New Approaches to Validation in Population-based Studies

CRS具有致残性，并与高直接和间接成本相关，但对其流行病学、病因异质性以及个人和社会负担知之甚少。在理解如何构建CRS的研究需求和改善患者预后方面存在很大差距。该项目将利用盖辛格诊所的独特数据和人口资源，包括宾夕法尼亚州30多个县的40万名初级保健患者，完成对CRS的大规模流行病学研究。我们将把纵向自我报告和电子健康记录数据与新的临床和研究测量相结合，以解决理解上的差距。虽然对CRS的自然史了解相对较少，但很明显：一般人群中的许多患者都有鼻腔和鼻窦症状；其中一些患者被诊断为过敏性鼻炎或急性呼吸道综合征发作（症状持续7天至4周，以排除患有普通感冒的患者）；其中一些患者进展为CRS，症状至少持续12周；许多CRS患者有发作性加重，症状明显加重于基线；许多患者，特别是那些在三级中心看到的患者，有顽固性CRS；自然历史必须包括一些治疗性的和可能自发的缓解。框架中每个步骤的发病率、流行率、转换率和风险因素尚不清楚。由于基于人群样本的研究相对较少，大多数研究可能集中在治疗失败的患者，即顽固性组。在拟议的研究中，我们将使用临床验证的标准对代表CRS全谱的一般人群样本估计CRS的患病率、发病率和缓解；描述CRS恶化和缓解的模式以及解释变异性的因素；确定有无鼻息肉的CRS有何不同；利用现有关键环境条件的地理空间数据，评估CRS的各种社区环境风险因素；估算CRS的直接和间接成本。

CRS is disabling and is associated with high direct and indirect costs, yet little is known about the epidemiology, etiologic heterogeneity, and individual and societal burden. There is a substantial gap in understanding how to frame research needs for CRS and improve patient outcomes. This project will complete a large-scale epidemiologic study of CRS by leveraging the unique data and population assets of the Geisinger Clinic, including a primary care population of 400,000 patients in over 30 counties in Pennsylvania. We will combine longitudinal self-reported and electronic health record data with new clinical and research measurements to address gaps in understanding. While relatively little is known about the natural history of CRS, it is clear that: many patients in the general population have nasal and sinus symptoms; some of these patients are diagnosed with allergic rhinitis or episodes of ARS (symptoms for 7d to 4wk, to eliminate patients with the common cold); some of these patients progress to CRS with symptoms present for at least 12 weeks; many patients with CRS have episodes of exacerbations, with a prominent worsening of symptoms over the baseline; many patients, especially those seen in tertiary centers, have recalcitrant CRS; and the natural history must include some therapeutic and probably spontaneous remissions. The incidence, prevalence, transition rates, and risk factors for each ofthe steps in the framework are not well known. Since relatively little research exists in population-based samples, it is likely that most studies have focused on patients who have failed therapy, the recalcitrant group. In the proposed research, we will estimate CRS prevalence, incidence, and remission using clinically validated criteria for general population samples that represent the full spectrum of CRS; describe patterns of CRS exacerbation and remission and the factors that explain variability; determine how CRS with and without nasal polyps cases differ from each other; evaluate a variety of community environmental risk factors for CRS using existing geospatial data on key environmental conditions; and estimate the direct and indirect costs of CRS.