Associations of environmental and community features with radiologic sinus inflammation in Pennsylvania, USA

Background: Chronic rhinosinusitis is a disease of the nasal and sinus mucosa with direct and indirect costs for individuals and society, including the risk of transition to lower airway diseases. Using electronic health records from the Geisinger Health System in Pennsylvania, we evaluated associations of environmental and community features as surrogates for aeroallergens with radiologic sinus inflammation, an objective finding of chronic rhinosinusitis. Methods: In a nested case-control study using electronic health records data, we included individuals aged 18-80 years from 2008 to 2018, with two encounters in the 4 years before their index date, and residence in a 38-county study region. We identified cases (n = 2,382) with radiologic sinus inflammation using a validated text algorithm applied to sinus computed tomography scan reports. Controls (n = 11,910) were frequency-matched on age, sex, and year of encounter. Exposures were assigned based on the residential address within latency and duration windows. We used logistic regression with robust standard errors clustered on community to estimate odds ratios and 95% confidence intervals while adjusting for confounding variables. Results: Cases and controls had a mean (SD) age of 49.5 (15.3) years, were predominantly non-Hispanic White (96%), and had a mean (SD) contact time with the Geisinger Health System of 5.88 (3.29) years. We found independent associations of greater urbanization, higher greenness, higher cumulative growing degree days, and lower precipitation with increased odds of radiologic sinus inflammation. Residence in higher density urban areas (compared with rural) was strongly associated (odds ratio [95% confidence interval]) with radiologic sinus inflammation (1.70 [1.31, 2.21]). Conclusions: Higher cumulative growing degree days, greater urbanization, lower precipitation, and higher greenness had robust associations with radiologic sinus inflammation. Findings reflect the complexity of environmental and community risk factors that directly and indirectly influence radiologic sinus inflammation, including both aeroallergens and air pollutants. Risk of this objective finding of chronic rhinosinusitis could increase with continued climate change-driven variation in weather and land use.