Female patients were more likely to have chronic rhinosinusitis without nasal polyps and less likely to have chronic rhinosinusitis with nasal polyps than male patients, according to a cross-sectional analysis of more than 258,000 adults in the United States.
Overall, 12% of women and 9% of men were diagnosed with chronic rhinosinusitis (CRS). Chronic rhinosinusitis without nasal polyps (CRSsNP) occurred in 11% of women and 8% of men, while chronic rhinosinusitis with nasal polyps (CRSwNP) affected 0.7% of women and 1% of men. Among those with CRSsNP, women had lower eosinophil counts and total immunoglobulin E (IgE) levels than men.
The study was based on data from the National Institutes of Health All of Us Research Program (2018–2023), including 159,122 female and 99,123 male participants. Diagnoses were identified using Systematized Nomenclature of Medicine and International Classification of Diseases codes, and subtypes were confirmed through manual review of medical records. Associations between sex and CRS subtypes were examined using multivariable logistic regression, while biomarker differences were assessed with multiple linear regression adjusted for demographic and clinical factors. Eosinophil counts and total IgE served as indicators of type 2 inflammatory activity.
Women consistently showed lower eosinophil and IgE levels than men, suggesting reduced type 2 inflammation. The likelihood of CRSsNP increased until about age 60 before declining, with a sharper decrease among women; CRSwNP prevalence remained stable across age groups.
"Our findings raise additional questions regarding the effect of hormone-modifying states such as menopause and hormonal drug use on the development and progression of CRS," said lead study author Richard G. Chiu, BS, of the Department of Otolaryngology, University of Illinois College of Medicine, and colleagues.
The study had several limitations. Participants without complete electronic health record data were excluded, which may have introduced selection bias. CRS diagnoses were based on coded medical records and not verified through imaging or endoscopy, allowing possible misclassification. Socioeconomic variables such as income, education, and insurance were self-reported, introducing potential bias. Some biomarker analyses relied on smaller subsets, limiting generalizability. The cross-sectional design also limited causal inference, and reliance on coded diagnoses instead of standardized evaluations may have led to misclassification. The use of ICD-9 and ICD-10 codes could have introduced bias in identifying CRSwNP. Data on prior CRS surgeries were unavailable, limiting interpretation of disease severity and recurrence. The observed CRSwNP prevalence was lower than previous estimates, suggesting underdiagnosis in the dataset. Although statistically significant, sex-based differences were small and should be interpreted with caution.
The authors noted that sex-based variations in CRS phenotypes and inflammatory profiles underscore the need to account for biological sex in airway disease research and treatment studies. Identifying non–type 2 inflammatory patterns among women may help refine classification and diagnosis and guide precision-medicine approaches.
This study was supported by the All of Us Research Program, part of the National Institutes of Health (NIH), and used the All of Us Researcher Workbench tools. The NIH had no role in the design, conduct, analysis, or publication decisions. Full disclosures can be found in the published study.