Socioeconomic Inequities in Adherence to Positive Airway Pressure Therapy in Population-Level Analysis
Patel, Salma I
AffiliationUniv Arizona, UAHS Ctr Sleep & Circadian Sci
Univ Arizona, Dept Med, Div Pulm Allergy Crit Care & Sleep Med
Univ Arizona, Dept Pediat, Div Pulm & Sleep Med
positive airway pressure therapy
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CitationPandey, A.; Mereddy, S.; Combs, D.; Shetty, S.; Patel, S.I.; Mashaq, S.; Seixas, A.; Littlewood, K.; Jean-Luis, G.; Parthasarathy, S. Socioeconomic Inequities in Adherence to Positive Airway Pressure Therapy in Population-Level Analysis. J. Clin. Med. 2020, 9, 442.
JournalJOURNAL OF CLINICAL MEDICINE
RightsCopyright © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
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Abstract(a) Background: In patients with sleep apnea, poor adherence to positive airway pressure (PAP) therapy has been associated with mortality. Regional studies have suggested that lower socioeconomic status is associated with worse PAP adherence but population-level data is lacking. (b) Methods: De-identified data from a nationally representative database of PAP devices was geo-linked to sociodemographic information. (c) Results: In 170,641 patients, those in the lowest quartile of median household income had lower PAP adherence (4.1 + 2.6 hrs/night; 39.6% adherent by Medicare criteria) than those in neighborhoods with highest quartile median household income (4.5 + 2.5 hrs/night; 47% adherent by Medicare criteria; p < 0.0001). In multivariate regression, individuals in neighborhoods with the highest income quartile were more adherent to PAP therapy than those in the lowest income quartile after adjusting for various confounders (adjusted Odds Ratio (adjOR) 1.18; 95% confidence interval (CI) 1.14, 1.21; p < 0.0001). Over the past decade, PAP adherence improved over time (adjOR 1.96; 95%CI 1.94, 2.01), but health inequities in PAP adherence remained even after the Affordable Care Act was passed. (d) Conclusion: In a nationally representative population, disparities in PAP adherence persist despite Medicaid expansion. Interventions aimed at promoting health equity in sleep apnea need to be undertaken.
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Except where otherwise noted, this item's license is described as Copyright © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
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