title: Ethnic disparities in CPAP adherence in New Zealand: effects of socioeconomic status, health literacy and self-efficacy.
abstract: OBJECTIVE
  We aimed to investigate the influence of ethnicity on adherence with continuous positive airway pressure (CPAP) in a sample of New Zealand patients.
  
  
  METHODS
  Observational study over one month.
  
  
  METHODS
  A university-based sleep laboratory.
  
  
  METHODS
  126 consecutively consenting CPAP-naïve patients (19.8% Māori, mean±SD apnea-hypopnea index 57.9 ± 38.9 events/h, CPAP 11.1 ± 3.1 cm H2O).
  
  
  METHODS
  Patients underwent a 4-week supervised home trial of CPAP following pressure titration.
  
  
  RESULTS
  Self-identified ethnicity (Māori/non-Māori), Epworth Sleepiness Scale, Self-Efficacy Measure for Sleep Apnea, Rapid Estimate of Adult Literacy in Medicine, New Zealand Deprivation Index (calculated from residential address), New Zealand Individual Deprivation Index (validated 8-item questionnaire), educational history, income, and employment assessed at baseline were compared to objective CPAP adherence after one month. Māori demonstrated significantly lower usage than non-Māori (median 5.11, interquartile range 2.24 h/night compared with median 5.71, interquartile range 2.61 h/night, P = 0.05). There were no significant relationships between adherence and subjective sleepiness, health literacy, or self-efficacy. In a multivariate logistic regression model incorporating 5 variables (ethnicity, eligibility for government-subsidized healthcare, individual deprivation scores, income, and education), non-completion of tertiary education, and high individual socioeconomic deprivation remained significant independent predictors of average CPAP adherence not reaching ≥ 4 h (odds ratio 0.25, 95% CI 0.08-0.83, P = 0.02; odds ratio 0.10, 95% CI 0.02-0.86, P = 0.04, respectively). The overall model explained approximately 23% of the variance in adherence.
  
  
  CONCLUSIONS
  The disparity in CPAP adherence demonstrated between Māori and non-Māori can be explained in part by lower education levels and socioeconomic status.
authors: WellSleep Sleep Investigation Centre, Department of Medicine, University of Otago, Wellington, New Zealand. jessie.bakker@otago.ac.nz
authors: Jessie P
authors: JP
authors: Bakker
authors: Karyn M
authors: KM
authors: O'Keeffe
authors: Alister M
authors: AM
authors: Neill
authors: Angela J
authors: AJ
authors: Campbell
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000523:psychology*; D005006:Ethnicity / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D057220:Health Literacy; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D010349:Patient Compliance / Q000208:ethnology / Q000523:psychology* / Q000706:statistics & numerical data; D020377:Self Efficacy; D012891:Sleep Apnea Syndromes / Q000208:ethnology / Q000523:psychology / Q000628:therapy; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data