Chronic rhinosinusitis - Epidemiological studies on occupational exposure, obesity and sick leave

Abstract

Chronic rhinosinusitis (CRS) is a disease characterised by chronic inflammation of the mucosa lining the nose and paranasal sinuses, with a significant negative impact on patients’ quality of life. CRS affects around 11% of the population of Europe, and currently there is no curative, but only symptomatic, treatment. For the majority of patients, the cause of CRS is unknown. Risk factors include asthma, smoking and allergy, and in recent years occupational exposure has been acknowledged as a contributing cause. However, there is a scarcity of studies on CRS that use the current definition stipulated by the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) and deal with occupational exposures. The papers appended to this thesis relate to the Telemark population study in the south of Norway. The aim of this thesis was to investigate further the epidemiology of CRS, with the focus on occupational exposures, obesity and sick leave. Paper I comprises a cross-sectional study in which the prevalence of CRS in the Telemark population was 9% in 2013. Occupational exposure to paper dust, cleaning agents, metal dust, animals, mould/moisture/mildew and physically strenuous work was associated with an increased odds of having CRS. Paper II describes a prospective study in which occupational exposures to hair-care products, cleaning agents (among women), super glue, strong acids, cooking fumes, and wood dust were associated with an increased odds of new-onset CRS in a 5-year period (2013–2018). The cumulative, 5-year incidence of new-onset CRS in the Telemark population was found to be 5.5%. Paper III represents a prospective study for the period of 2013–2018 in which the odds of new-onset CRS was found to be 53% higher in obese subjects (BMI≥30) than in subjects with normal weight (18.5≤BMI<25). Paper IV describes an investigation of the frequency of sick leave among subjects in the previous 12 months, cross-sectionally in 2013 and 2018. Subjects with CRS had around a 60% increased odds of taking sick leave, as compared with subjects without CRS, in both 2013 and 2018. When stratifying for sex in 2013, women with CRS had an almost two-fold higher odds of taking sick leave compared to men with CRS. Sick leave was found to be more common for subjects with CRS than for subjects without CRS in some occupational groups. The main conclusions from this thesis work are that: 1) occupational exposure is a risk factor for CRS, and particular consideration should be given to cleaning agents, hair-care products, paper dust, metal dust, animals, mould/moisture/mildew, super glue, strong acids, cooking fumes and wood dust; 2) high BMI is a risk factor for CRS and should be taken into consideration when assessing patients with CRS; and 3) subjects with CRS in the Telemark population have a higher frequency of sick leave in the previous year compared to subjects without CRS and, in this context, women appear to be more affected than men.