Neighborhoods with Greater Prevalence of Minority Residents Have Lower Continuous Positive Airway Pressure Adherence.

Tytuł:: Neighborhoods with Greater Prevalence of Minority Residents Have Lower Continuous Positive Airway Pressure Adherence.
Autorzy:: Borker PV; Center for Sleep and Cardiovascular Outcomes Research.; Division of Pulmonary Allergy and Critical Care Medicine.
Carmona E; Center for Sleep and Cardiovascular Outcomes Research.
Essien UR; Center for Health Equity and Promotion, and.; Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and.
Saeed GJ; Center for Sleep and Cardiovascular Outcomes Research.
Nouraie SM; Division of Pulmonary Allergy and Critical Care Medicine.
Bakker JP; Philips Respironics, Monroeville, Pennsylvania.
Stitt CJ; Philips Respironics, Monroeville, Pennsylvania.
Aloia MS; Philips Respironics, Monroeville, Pennsylvania.
Patel SR; Center for Sleep and Cardiovascular Outcomes Research.; Division of Pulmonary Allergy and Critical Care Medicine.
Źródło:: American journal of respiratory and critical care medicine [Am J Respir Crit Care Med] 2021 Aug 01; Vol. 204 (3), pp. 339-346.
Typ publikacji:: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
Język:: English
Imprint Name(s):: Publication: 2000- : New York, NY : American Thoracic Society
Original Publication: New York, NY : American Lung Association, c1994-
MeSH Terms:: Continuous Positive Airway Pressure*
Ethnicity/*statistics & numerical data
Minority Groups/*statistics & numerical data
Residence Characteristics/*statistics & numerical data
Sleep Apnea, Obstructive/*therapy
Treatment Adherence and Compliance/*statistics & numerical data
Adult ; Black or African American ; Aged ; Educational Status ; Female ; Healthcare Disparities/ethnology ; Hispanic or Latino ; Humans ; Insurance Coverage ; Male ; Middle Aged ; Poverty ; White People
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Grant Information:: IK2 HX003176 United States HX HSRD VA; K24 HL127307 United States HL NHLBI NIH HHS; T32 HL082610 United States HL NHLBI NIH HHS
Contributed Indexing:: Keywords: Black; CPAP adherence; Hispanic; disparities; neighborhood
Entry Date(s):: Date Created: 20210310 Date Completed: 20210920 Latest Revision: 20221207
Update Code:: 20240105
PubMed Central ID:: PMC8513592
DOI:: 10.1164/rccm.202009-3685OC
PMID:: 33689593
: Czasopismo naukowe

Rationale: Limited data suggest racial disparities in continuous positive airway pressure (CPAP) adherence exist. Objectives: To assess whether CPAP adherence varies by neighborhood racial composition at a national scale. Methods: Telemonitoring data from a CPAP manufacturer database were used to assess adherence in adult patients initiating CPAP therapy between November 2015 and October 2018. Mapping ZIP code to ZIP code tabulation areas, age- and sex-adjusted CPAP adherence data at a neighborhood level was computed as a function of neighborhood racial composition. Secondary analyses adjusted for neighborhood education and poverty. Measurements and Main Results: Among 787,236 patients living in 26,180 ZIP code tabulation areas, the prevalence of CPAP adherence was 1.3% (95% confidence interval [CI], 1.0-1.6%) lower in neighborhoods with high (⩾25%) versus low (<1%) percentages of Black residents and 1.2% (95% CI, 0.9-1.5%) lower in neighborhoods with high versus low percentages of Hispanic residents ( P < 0.001 for both), even after adjusting for neighborhood differences in poverty and education. Mean CPAP usage was similar across neighborhoods for the first 2 days, but by 90 days, differences in CPAP usage increased to 22 minutes (95% CI, 18-27 min) between neighborhoods with high versus low percentages of Black residents and 22 minutes (95% CI 17-27 min) between neighborhoods with high versus low percentages of Hispanic residents ( P < 0.001 for both). Conclusions: CPAP adherence is lower in neighborhoods with greater proportions of Black and Hispanic residents, independent of education or poverty. These differences lead to a lower likelihood of meeting insurance coverage requirements for CPAP therapy, potentially exacerbating sleep health disparities.

Comment in: Am J Respir Crit Care Med. 2021 Aug 1;204(3):252-254. (PMID: 33844933)
Comment in: Am J Respir Crit Care Med. 2021 Sep 1;204(5):614-615. (PMID: 34133909)
Comment in: Am J Respir Crit Care Med. 2021 Sep 1;204(5):615-616. (PMID: 34133914)

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