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.
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.
Authors: Douglas M Wallace; Natasha J Williams; Amy M Sawyer; Girardin Jean-Louis; Mark S Aloia; Dorice L Vieira; William K Wohlgemuth Journal: Sleep Med Rev Date: 2017-04-13 Impact factor: 11.609
Authors: Martha E Billings; Dennis Auckley; Ruth Benca; Nancy Foldvary-Schaefer; Conrad Iber; Susan Redline; Carol L Rosen; Phyllis Zee; Vishesh K Kapur Journal: Sleep Date: 2011-12-01 Impact factor: 5.849
Authors: Miranda R Jones; Ana V Diez-Roux; Anjum Hajat; Kiarri N Kershaw; Marie S O'Neill; Eliseo Guallar; Wendy S Post; Joel D Kaufman; Ana Navas-Acien Journal: Am J Public Health Date: 2014-09-11 Impact factor: 9.308
Authors: Nathalia Velasquez; John A Moore; Robert M Boudreau; Leila J Mady; Stella E Lee Journal: Int Forum Allergy Rhinol Date: 2019-10-29 Impact factor: 3.858
Authors: Martha E Billings; Robyn T Cohen; Carol M Baldwin; Dayna A Johnson; Brian N Palen; Sairam Parthasarathy; Sanjay R Patel; Maureen Russell; Ignacio E Tapia; Ariel A Williamson; Sunil Sharma Journal: Chest Date: 2020-09-30 Impact factor: 10.262
Authors: Meena Khan; Andre Stone; Ryan J Soose; Samuel M Cohen; Javier Howard; Robson Capasso; Deeyar Itayem; M Boyd Gillespie; Reena Mehra; Eugene Chio; Patrick J Strollo; Anna Menzl; Adam Kaplan; Quan Ni Journal: J Clin Sleep Med Date: 2022-09-01 Impact factor: 4.324
Authors: Rebecca Robbins; Katherine A Dudley; Kristen N Monten; Colin Le; Sherry Hanes; Sanjay R Patel; Suzanne M Bertisch Journal: ATS Sch Date: 2022-01-04