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Original Investigation |

Prevalence and Incidence of Diagnosed Chronic Rhinosinusitis in Alberta, Canada ONLINE FIRST

Yuan Xu, MD, MSc1,2; Hude Quan, MD, PhD1; Peter Faris, PhD1; Stephanie Garies, MPH3; Mingfu Liu, PhD2; Ceris Bird, BSc2; Edward Kukec, MBA2; Stafford Dean, PhD1; Luke Rudmik, MD, MSc1,4
[+] Author Affiliations
1Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
2Data Integration, Measurement and Reporting, Alberta Health Services, Calgary, Alberta, Canada
3Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
4Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
JAMA Otolaryngol Head Neck Surg. Published online September 08, 2016. doi:10.1001/jamaoto.2016.2227
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Importance  Reported prevalence rates of chronic rhinosinusitis (CRS) range from 1% to 12% worldwide. To facilitate appropriate health service delivery and resource allocation, it is important to improve the estimated burden of CRS to the health care system.

Objectives  To assess the prevalence and incidence of diagnosed CRS in Alberta, Canada, from the perspective of the health care system and to evaluate the 10-year temporal trend and geographic variation of diagnosed CRS.

Design, Setting, and Participants  From provincial-wide physicians’ claim data, a CRS cohort was identified using a validated case definition. The population at the midpoint (2008-2009) of the study period (2 925 930) was used as the reference. The crude as well as age- and sex-standardized incidence and prevalence rates were calculated. The age-specific incidence and prevalence by sex were also assessed in each study year. Small-area variation analysis was conducted using extremal quotient, weighted coefficient of variation, χ2 statistic, systematic component of variation, and empirical Bayes variance estimate.

Results  Of the 2 925 930 individuals in the study at midpoint (2008-2009), 1 451 261 (49.6%) were women, and the mean (SD) age was 45 (17) years. From fiscal year 2004-2005 to fiscal year 2013-2014, the mean age- and sex-standardized incidence of diagnosed CRS was 2.5 (range, 2.3-2.7) per 1000 population. The estimated prevalence based on age-specific incidence varied between 18.8 (95% CI, 18.7-18.9) and 23.3 (95% CI, 23.1-23.5) per 1000 population during 2004-2005 to 2013-2014, and no obvious growing trend was found. There was high geographic variation in the diagnosed incidence and prevalence of CRS (mean systematic component of variation, 19.4 and 12.3, respectively).

Conclusions and Relevance  Although the incidence and prevalence rates of diagnosed CRS were lower compared with earlier published estimates obtained from population-based survey analysis, outcomes from this study may more accurately reflect the disease burden of CRS to the health care system. Given that the prevalence of CRS within a single province is expected to be uniformly distributed, the large geographic variation in diagnosed CRS indicates a potential gap in quality of care and justifies further investigation into the reasons for the variation.

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Figure 1.
Age- and Sex- Standardized Incidence and Prevalence of Diagnosed Chronic Rhinosinusitis From 2004-2005 to 2013-2014

The estimated prevalence was calculated based on the age-specific incidences in the same year.

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Figure 2.
Regional Variation in Diagnosed Chronic Rhinosinusitis (CRS)

Variation in incidence (A) and prevalence (B) of CRS in 2012-2013. Reproduced with permission from Alberta Health Services.

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