Impact of Life‐Context Factors on Chronic Rhinosinusitis 22‐Item Sinonasal Outcomes Test: Systematic Review + Meta‐Analysis

OBJECTIVE: Chronic rhinosinusitis (CRS) affects all sociodemographic groups. While studies have explored social determinants of health (SDOH), sociodemographics, and health behaviors, their specific effects on CRS outcomes are unclear, making tailored care difficult. This review examines how these "Life-Context" factors influence 22-item Sinonasal Outcome Test (SNOT-22) scores before and after treatment. DATA SOURCES: A systematic review followed PRISMA guidelines, searching Medline, Embase, Cochrane CENTRAL, and Web of Science through 12/2024. REVIEW METHODS: Eligible CRS studies with comparison groups reporting SNOT-22 outcomes were reviewed. Mixed Methods Appraisal Tool assessed bias. Random-effects meta-analysis estimated the pooled effect on SNOT-22 when two studies reported comparable cohorts. RESULTS: Of 3180 records identified, 61 studies met inclusion criteria. Females had worse baseline SNOT-22 scores, but similar improvements postsurgery as males (baseline SMD = 0.30, 95% CI: 0.24-0.36; 2-years postsurgery: SMD = 0.04, 95% CI: -0.33-0.41). Younger patients often had higher baseline SNOT-22. Race and ethnicity data were limited and variable; no significant differences were found. Education and income showed inconsistent links to SNOT-22 scores. Medicaid and private insurance patients had worse baseline scores than Medicare (SMD = 0.81, 95% CI: 0.48-1.15 and 0.30, 95% CI: 0.10-0.49, respectively). Smokers had worse SNOT-22 (SMD = 0.37, 95% CI: 0.22-0.53). Environmental factors showed weak, inconsistent effects. There is limited data on food security, social support, and care access. CONCLUSION: Various Life-Context factors influence CRS and affect SNOT-22 outcomes. Specifically, factors like sex, ethnicity, insurance status, and smoking impact these outcomes. Variability in studies and reporting methods hinder clear conclusions. Standardized data collection on these factors is vital for improving understanding and ensuring equitable care.