Biological sex differences in rhinitis prevalence among adults in the United States: An “All of Us” Research Program database analysis

Clinical ImplicationsFemale sex is associated with allergic rhinitis among adults but not with nonallergic rhinitis.These findings could support a role of sex hormones in the pathogenesis of allergic rhinitis and nasal inflammation, but more research is needed to establish causation.Rhinitis refers to a constellation of symptoms resulting from nasal mucosal dysfunction and is categorized into allergic rhinitis (AR) and nonallergic rhinitis (NAR). 1 AR is an IgE-mediated reaction of the nasal mucosa to allergens, whereas NAR is a heterogeneous group of disorders without allergen sensitization. 1,2In the pathogenesis of inflammation-mediated conditions, sex hormones have garnered increased attention because of their extensive role in immune modulation. 3More specifically, testosterone and progesterone have been shown to have immunosuppressive effects, whereas estrogen has mixed proinflammatory and anti-inflammatory effects. 3,4The role of these hormones in inflammation forms a pathophysiological basis to anticipate sex differences in rhinitis prevalence.Clinically, women have an increased incidence of atopic and autoimmune disorders, 5,6 suggesting higher levels of immune reactivity.However, the role of biological sex in rhinitis remains unclear.Primary literature investigating sex differences in rhinitis among adults is sparse with existing studies tending to favor a higher prevalence among females, 7 although some studies have suggested no sex difference. 8However, many of these studies were conducted outside of the United States and thus may not be generalizable to the US population.Thus, our study aims to investigate this association using data from the All of Us Research Program (AoURP) Controlled Tier Dataset v7, available to authorized users on the Researcher Workbench.AoURP is a national dataset of US adults aggregating data through surveys, electronic health records, biosamples, and physical measurements. 9Participants are 18 years of age or older at the time of inclusion in AoURP.Because AoURP is deidentified, this study was exempt by the institutional review board.Diagnoses in AoURP are derived from medical records via Systemized Nomenclature of Medicine and International Classification of Diseases codes.AoURP then converts these codes into standardized vocabulary.We extracted data regarding