Discussion
Chronic rhino sinusitis appears to be prevalent in the Middle East regions more than others across the world. This study reported high prevalence of CRS (59.9%) using EP3OS, which is relatively close and a little higher than that observed in previous Saudi study 2017 which reveal a prevalence of 50% (18), and the self-reported previously doctor diagnosed chronic rhinosinusitis in our study represented 25.4% of the study population. This reported prevalence are higher than that observed in a USA study which revealed prevalence of 11.9% in 2017, and two Canadian studies that also showed a lower prevalence of CRS in comparison to our study (5% and 18.8-23.3% respectively). (19-20-21) However, an Iranian study reported a prevalence of 28.4% according to the criteria of EPOS, and 20% based on the clinical diagnosed CRS.(22) This relatively high prevalence of CRS in our region could be attributable to Jazan weather that has a dusty season each year.
Our results found that CRS was significantly associated with age group difference (p <0.05), which is similar to a Korean study in 2011, and other two Chinese and Canadian studies that showed significant association between the distribution of age and having CRS.(20- 23) No significant association between gender, residency, marital status or level of education and CRS was observed in contrast to that in China 2012, that revealed CRS is differ significantly with gender in agreement also with the Canadian and Korean results. (23)
CRS significantly impair health related quality of life of patients that lead to lost productivity secondary to absenteeism and subsequent risk of depression. (24)Many international studies have shown that CRS impair quality of life. However, to the best of our knowledge, this is first population-based study in Jazan Province evaluating health related quality of life, loss of productivity and risk of depression in patients with CRS. In the present study, MMS classification of quality of life affection by using (SNOT-22) show 159 (24.77%) of patients in moderate category with 483 (75.23%) which form the majority of patients classified as severe. A study by Sahlstrand-Johnson et al. revealed that CRS severity and quality of life affection in patients as 9.8% mild, 37.6% moderate and 52.7 and the patients in our study had statistically significantly higher SNOT-22 score (mean 69.14 + 24.6 vs 51.8). (25) Depression is the second most common mental health in patients with CRS as previous studies on relationship between CRS and depression has shown a significant association between the two diseases, Schlosser et al., found that 24.4% of patients with CRS at risk of developing depression using PHQ-2. (9)
The prevalence of depression in patient with CRS is approximately between 9% and 40%. (12) In our study we found that 507 (78.97%) of CRS patients are at risk of depression.
This prevalence is very similar to that reported in Taiwan population-based cohort study conducted by Nyaiteera et al.(14), which demonstrated that the overall prevalence of depression was 77% using a different validated screening instrument. There have been reports on cost effect of lost productivity secondary to CRS. A study conducted by Beswick et al., found that the mean of loss productivity was 5.1 days as a result of allergic rhinitis and common cold. (16)
Another recent study published by Wasan et al. , reported the mean of lost days of productivity in last three months was 3.1 due to CRS which is consistent with the result in this study that show the mean number of absence days and lost productivity in the preceding three months was 3.30 due to CRS. (11) Sahlstrand-Johnson et al., fount that over half of participants 57% reported absenteeism secondary to sinus problems. (25)In our study only 215 (33.5%) of patients report absenteeism due to CRS which is lower in comparison with previous literature. In the present study we are interested to measure the association of risk of major depressive disorders and loss of productivity with the affection quality of life of CRS patients. A significant difference in risk of depression was present between levels of quality of life affection where, it has been observed that 425 (88%) patients with severely affected quality of life (SNOT-22 score > 50) are at higher risk of depression. Our study is consistent with many previous studies that reported a strong association between the total SNOT-22 score and depression scores.(9-13) there was also an observed significant difference in the absences from work due to CRS within the levels of quality of life affection in the present study as higher rates of absences were found in the group with severely affected quality of life. Hoehle et al., reported that the significant lost productivity was associated with worsening of CRS symptoms severity and QoL.(8)