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

CRS 流行病学在基于人群的研究中使用新方法进行验证

• 批准号: 9321414
• 负责人: BRIAN Seth SCHWARTZ
• 金额: $ 52.97万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9321414
• 关键词: Address; Adrenal Cortex Hormones; Agriculture; Allergic rhinitis; Ambulatory Care; Antibiotics; Asthma; Cells; Chronic; Clinic; Clinical; Clinical Research; Common Cold; Communities; County; DNA; Data; Data Reporting; Diagnosis; Direct Costs; Disease; Disease remission; Drainage procedure; Electronic Health Record; Environmental Risk Factor; Epidemiology; Etiology; Facial Pain; Facilities and Administrative Costs; Gastroesophageal reflux disease; General Population; Health; Health Insurance; Heterogeneity; Impairment; Incidence; Individual; Inflammation; Instruction; Irrigation; Measurement; Measures; Mediating; Migraine; Mining; Modeling; Nasal Polyps; Nasal obstruction present finding; Natural History; Nose; Obstruction; Operative Surgical Procedures; Outcome; Pain; Patient Care; Patient Self-Report; Patient-Focused Outcomes; Patients; Pattern; Pennsylvania; Phase; Phenotype; Population; Population Study; Prevalence; Primary Health Care; Provider; Publishing; Quality of life; Research; Risk Factors; Sampling; Serum; Severities; Sinus; Smell Perception; Source; Spontaneous Remission; Surveys; Symptoms; Syndrome; System; Therapeutic; Time; Transportation; Treatment Effectiveness; Validation; Variant; Visit; Work; acute rhinosinusitis; base; burden of illness; care seeking; chronic rhinosinusitis; cost; design; disease heterogeneity; epidemiology study; health care service utilization; improved; novel strategies; population based; pressure; programs; tertiary care

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.

CRS 具有致残性，并与较高的直接和间接成本相关，但人们对流行病学、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 研究需求和改善患者治疗结果方面存在很大差距。该项目将利用 Geisinger Clinic 的独特数据和人口资产完成一项大规模的 CRS 流行病学研究，其中包括宾夕法尼亚州 30 多个县的 400,000 名初级保健患者。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。虽然人们对 CRS 的自然史知之甚少，但很明显： 普通人群中的许多患者有鼻腔和鼻窦症状；其中一些患者被诊断为过敏性鼻炎或ARS发作（症状持续7天至4周，以消除普通感冒患者）；其中一些患者进展为 CRS，且症状持续至少 12 周；许多慢性鼻窦炎患者会出现病情加重的情况，症状较基线明显恶化；许多患者，尤其是在三级中心就诊的患者，患有顽固性 CRS；自然病史必须包括一些治疗性的、可能自发的缓解。该框架中每个步骤的发病率、患病率、转移率和风险因素尚不清楚。由于基于人群的样本研究相对较少，因此大多数研究可能都集中在治疗失败的患者（即顽固组）上。在拟议的研究中，我们将使用代表全谱 CRS 的一般人群样本的临床验证标准来估计 CRS 患病率、发病率和缓解率；描述 CRS 恶化和缓解的模式以及解释变异性的因素；确定伴有和不伴有鼻息肉病例的 CRS 有何不同；使用关键环境条件的现有地理空间数据评估 CRS 的各种社区环境风险因素；并估算 CRS 的直接和间接成本。