title: Racial disparity in adherence to positive airway pressure among US veterans.
abstract: OBJECTIVE
  Despite advances in continuous positive airway pressure (CPAP) technology, compliance with CPAP therapy remains suboptimal. Studies conducted since the advent of objective CPAP recording have noted that African Americans (AA) may use CPAP less than Whites. We sought to confirm this finding among a large sample of veterans and examine effect modifiers of the differential usage.
  
  
  METHODS
  A retrospective cohort of 233 AA and 1939 White Veterans Administration (VA) patients who had a sleep study between January 2003 and October 2006 and received CPAP therapy by the end of 2007. CPAP compliance was summarized at 2 weeks and 6 months post CPAP receipt.
  
  
  RESULTS
  AAs were significantly less adherent than Whites even when controlling for age, gender, marital status, median household income for zip code, BMI, comorbidities, and obstructive sleep apnea (OSA) severity. AAs with severe OSA were 3 times more likely to use CPAP than AAs with mild/moderate OSA (p ≤ 0.001); a much smaller but still statistically significant difference was seen for Whites.
  
  
  CONCLUSIONS
  CPAP compliance is considerably lower in AAs than in Whites, though severity of OSA modifies this association. These findings are not readily explained by differences in demographics or comorbidity.
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health MDC-56, University of South Florida, Tampa, FL, 33612, USA. skaisw@aol.com.
authors.forename: Skai W
authors.initials: SW
authors.lastname: Schwartz
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health MDC-56, University of South Florida, Tampa, FL, 33612, USA.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Sebastião
authors.affiliation: Medical Service, James A. Haley VA Hospital, Tampa, FL, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Rosas
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health MDC-56, University of South Florida, Tampa, FL, 33612, USA.
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Iannacone
authors.affiliation: Laboratory Service, James A. Haley VA Hospital, Tampa, FL, USA.|Department of Pathology and Cell Biology, University of South Florida, Tampa, FL, USA.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Foulis
authors.affiliation: Medical Service, James A. Haley VA Hospital, Tampa, FL, USA.|Division of Pulmonary, Critical Care and Sleep Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: W McDowell
authors.initials: WM
authors.lastname: Anderson
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology*; D000368:Aged; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000208:ethnology* / Q000523:psychology*; D017286:Polysomnography; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000208:ethnology* / Q000523:psychology / Q000628:therapy*; D014481:United States; D014728:Veterans / Q000523:psychology*; D044465:White People / Q000523:psychology*
keywords: CPAP adherence; Obstructive sleep apnea; Racial disparity; Veterans
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