Comparative cross-sectional analysis of asthma outcomes and sinus surgery utilization in Appalachian and non-Appalachian counties of Ohio.

Abstract

Context: Healthcare inequities disproportionately affect underprivileged groups, leading to negative health outcomes. Challenges are compounded in regions like Appalachian Ohio, where rurality and poverty exacerbate issues such as access to care and environmental stressors, significantly impacting conditions like asthma. In severe cases of asthma, sinus surgery is sometimes indicated, because it has been shown to improve asthma-related symptoms. However, the specialists who perform these procedures, such as otolaryngologists, may be less available to certain underprivileged groups.

Objectives: The purpose of this study was to compare the effects of social determinants of health on the prevalence and treatment of asthma in Appalachian vs. non-Appalachian regions of Ohio, and how those factors affect the rate at which sinus surgery is performed in different populations.

Methods: This cross-sectional study utilized public data gathered in the year 2021 from the Centers for Disease Control and Prevention (CDC) and the Center for Medicare and Medicaid Services (CMS) to compare asthma prevalence, emergency visit and hospitalization rates, sinus surgery frequencies, and social determinants of health in Appalachian vs. non-Appalachian regions.

Results: Both the average prevalence rate of asthma (p<0.001) and the number of emergency department visits as a complication of asthma (p<0.01) in Appalachian Ohio counties were significantly higher than non-Appalachian counties. Interestingly, the ratio between sinus surgery prevalence and the number of procedures was not statistically different between Appalachian and non-Appalachian counties. This included balloon sinuplasty (p=0.4), septoplasty (p=0.4), and functional endoscopic sinus surgery (FESS, p=0.4). Additionally, several social determinants of health, specifically the poverty rate (r=0.9, p<0.001), uninsured rate (r=0.4, p<0.001), unemployment rate (r=0.5, p<0.001), and housing burden rate (r=0.6, p<0.001) were shown to have a significant correlation with the rate of asthma prevalence among adults in Ohio.

Conclusions: Asthma prevalence and treatment availability differ significantly between Appalachian and non-Appalachian regions of Ohio, highlighting the need to improve access to specialists and address barriers to care in rural populations.