{"doi":"10.1002/alr.23556","title":"Sex‐Based Disparities in Sinonasal Outcomes: A Population‐Based Study","abstract":"Sinonasal inflammatory/infectious disorders, including allergic rhinitis (AR) or hay fever and sinus infections, pose a major health burden in the United States, with significant health and economic impacts [1]. Sex hormones have increasingly been shown to play a role in the immune system [2]. Evidence at the cellular level supports testosterone's and progesterone's immunosuppressive effects and estrogen's mixed pro- and anti-inflammatory effects [3, 4]. Epidemiological data show sex differences in immune-mediated diseases like asthma and atopic dermatitis, as adult females have higher prevalence rates, suggesting a hormonal influence [5]. There is a paucity of epidemiologic literature on sex differences in AR, particularly in the United States [6]. A recent scoping review identified just seven studies with only one being a US population-based study, which found females were more likely to have AR [7, 8]. Similarly, the epidemiologic literature on other sinusitis besides chronic rhinosinusitis is limited and characterized by heterogeneous methodology and results and small sample sizes [8]. Using the National Health and Nutrition Examination Survey (NHANES) data, our study investigates sex-based differences in the prevalence of AR, sinus infections, and related symptoms, and across age groups. NHANES assesses the health and nutritional status of a nationally representative sample of noninstitutionalized individuals aged 2 months and older in the United States [9]. The 2005–2006 cycle was used as it was the only one with detailed sinonasal disease and symptom data. The exposure variable was sex at birth, and the outcome variables were lifetime self-reported doctor diagnosis of hay fever, allergies, and sinus infection, as well as recent self-reported (past 12 months) hay fever episodes, allergy symptoms, and problems with sneezing. Covariates, including age, race/ethnicity, family poverty income ratio (less than 1 means household income is below federal poverty level), interview language, health insurance coverage, smoking in home, and asthma history, were considered. Descriptive statistics were calculated, and bivariate analyses performed using chi-square or t-test as appropriate, to compare sample characteristics between sexes. To evaluate the association of sex and each outcome, we conducted both bivariate analyses and multivariable logistic regression analyses. A forwards selection approach was used to determine the final multivariable model. Data were then grouped by age decade to calculate the proportions of participants by age decade and sex for each outcome. A p value of <0.05 denoted statistical significance. All analyses were conducted using statistical software R (version 4.2.3). Characteristics of the study sample and bivariate analyses between males and females are detailed in Table 1. In the bivariate analyses, females had significantly higher prevalence of all sinonasal outcomes than males. Overall (n = 9264) Female (n = 4733) Male (n = 4531) Health insurance 0.014* In the multivariable analyses, females had increased odds of lifetime self-reported diagnosis of hay fever (OR: 1.32, 95% CI: 1.06–1.65), allergies (OR: 1.58, 95% CI: 1.40–1.80), and sinus infections (OR: 1.90, 95% CI: 1.62–2.23). Females also had increased odds of self-reported recent hay fever episodes (OR: 1.58, 95% CI: 1.17–2.14), allergy symptoms (OR: 1.60, 95% CI: 1.38–1.85), and sneezing (OR: 1.14, 95% CI: 1.01–1.29). As demonstrated in Figure 1, sinonasal outcome prevalence varied by age. Except for hay fever, where female predominance persisted across all age groups, lifetime self-reported diagnosis of allergies and sneezing problems were less prevalent in females before the age of 10 years and became more prevalent afterward, peaking during the 40–50 years age group. For recent self-reported sinonasal outcomes, hay fever was more prevalent in women across all ages, while allergies and sneezing problems showed male predominance in the 1–10 yea","journal":"International Forum of Allergy & Rhinology","year":2025,"id":543460,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9543,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1259134,"name":"Anthony I. Dick","orcid":null,"position":1,"is_corresponding":false},{"id":1433497,"name":"Khamis T. Suleiman","orcid":null,"position":2,"is_corresponding":false},{"id":465954,"name":"Jiehuan Sun","orcid":"0000-0002-5940-4822","position":3,"is_corresponding":false},{"id":487225,"name":"Sharmilee M. Nyenhuis","orcid":"0000-0002-7381-9733","position":4,"is_corresponding":false},{"id":487223,"name":"Kamal Eldeirawi","orcid":"0000-0001-8669-3802","position":5,"is_corresponding":false},{"id":366427,"name":"Victoria S. Lee","orcid":"0000-0003-3221-126X","position":0,"is_corresponding":true}],"reference_count":9,"raw_metadata":null,"created_at":"2026-07-19T02:53:04.088079Z","pmid":"40103446","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}