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

CRS是致残性的，并与高直接和间接成本有关，但对流行病学，病因异质性，个人和社会负担知之甚少。在理解如何制定CRS的研究需求和改善患者结局方面存在巨大差距。该项目将通过利用Geisinger诊所的独特数据和人口资产，包括宾夕法尼亚州30多个县的40万患者的初级保健人口，完成CRS的大规模流行病学研究。我们将联合收割机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的自然史知之甚少，但很明显：一般人群中的许多患者有鼻和鼻窦症状;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，以排除普通感冒患者）;这些患者中的一些进展为CRS，症状存在至少12周;许多CRS患者有急性加重发作，症状明显恶化超过基线; 2许多患者，尤其是在三级中心的患者，有反复发作的CRS; 3自然史必须包括一些治疗缓解和可能的自发缓解。发病率，患病率，转换率，和风险因素的框架中的每一个步骤是不为人知的。由于相对较少的研究存在于人口为基础的样本，很可能大多数研究都集中在治疗失败的患者，即抑郁症组。在拟议的研究中，我们将使用代表CRS全谱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CRS伴鼻息肉和不伴鼻息肉病例的差异;使用现有的地理空间数据对关键环境条件进行评估，评估CRS的各种社区环境风险因素;并估计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.