title: Disparities in obstructive sleep apnea and its management between a minority-serving institution and a voluntary hospital.
abstract: We assessed disparities in severity of obstructive sleep apnea (OSA) and associated comorbidities, as well as in provision of sleep medicine health care, between patients evaluated for OSA in a voluntary hospital (VH) primarily serving a middle-class population with health-care insurance and a city hospital-based minority-serving institution (MSI) largely treating lower income, uninsured, and indigent patients. A retrospective chart review of patients evaluated for OSA at the VH (n=200) and at the MSI (n=103) was performed. Despite similar age and apnea hypopnea index, MSI patients had a greater body mass index, higher daytime systemic blood pressure, more comorbid medical conditions, and a lower minimum sleep SaO2 than VH patients. Systemic hypertension, diabetes mellitus, asthma, and congestive heart failure were more prevalent in the MSI group. Forty-two percent of the MSI patients diagnosed with OSA failed to follow up for treatment compared with 7% in the VH group, p<0.001. Disparities in OSA-associated comorbid conditions, as well as in delivery of sleep medicine-related health care, were evident between the VH and MSI groups. These findings suggest that OSA may be an important factor contributing to socioeconomic-based differences in morbidity and mortality.
authors.affiliation: North Shore-Long Island Jewish Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, New York 11040, USA. greenber@lij.edu
authors.forename: Harly
authors.initials: H
authors.lastname: Greenberg
authors.forename: Jean
authors.initials: J
authors.lastname: Fleischman
authors.forename: Hossam E
authors.initials: HE
authors.lastname: Gouda
authors.forename: Angel E
authors.initials: AE
authors.lastname: De La Cruz
authors.forename: Ricardo
authors.initials: R
authors.lastname: Lopez
authors.forename: Karen
authors.initials: K
authors.lastname: Mrejen
authors.forename: Anna
authors.initials: A
authors.lastname: Web
authors.forename: Steven
authors.initials: S
authors.lastname: Feinsilver
mesh_terms: D001249:Asthma / Q000453:epidemiology / Q000208:ethnology; D015992:Body Mass Index; D015331:Cohort Studies; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000208:ethnology; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000208:ethnology; D004562:Electrocardiography; D004569:Electroencephalography; D004576:Electromyography; D004585:Electrooculography; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000208:ethnology; D006773:Hospitals, Municipal / Q000592:standards* / Q000706:statistics & numerical data; D006788:Hospitals, Voluntary / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D008913:Minority Groups; D017286:Polysomnography; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology / Q000628:therapy*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D014600:Utilization Review