title: Associations among Neighborhood, Race, and Sleep Apnea Severity in Children. A Six-City Analysis.
abstract: BACKGROUND
  Prior researchers found that individual-level environmental and social indicators did not explain the racial disparity in obstructive sleep apnea syndrome. Neighborhood socioeconomic variables, as well as risk factors for a range of adverse behavioral and health outcomes, may better explain this racial disparity and help identify modifiable intervention targets.
  
  
  OBJECTIVE
  To evaluate the associations of neighborhood socioeconomic variables with obstructive sleep apnea severity and to assess whether the neighborhood variables explain the association between race and obstructive sleep apnea severity.
  
  
  METHODS
  We performed a cross-sectional analysis of data of 774 children in six cities who participated in the Childhood Adenotonsillectomy Trial. The outcome variable was the apnea-hypopnea index (AHI). Neighborhood socioeconomic variables were obtained on the basis of the children's residential addresses and information in the American Community Survey. Regression models were used to assess the associations among neighborhood conditions, race, and AHI.
  
  
  RESULTS
  Higher poverty rate and percentage of single-female-headed households were associated with higher AHI (P = 0.008 and 0.002, respectively). African American race was associated with a 1.33 (1.08-1.64 95% confidence interval)-fold increase in AHI, adjusting for age and sex. After controlling for poverty rate or percentage of single-female-headed households with children, the association between race and AHI levels was no longer significant (P = 0.15 and 0.26, respectively), and the magnitude of race association decreased 34 or 55%, suggesting that the association between race and AHI levels was largely explained by poverty rate or percentage of single-female-headed households with children.
  
  
  CONCLUSIONS
  Neighborhood socioeconomic variables in comparison with individual-level socioeconomic indicators provides better explanations for the racial disparity in pediatric obstructive sleep apnea syndrome. Further research aimed at identifying factors that aggregate in disadvantaged neighborhoods and increase sleep apnea risk may suggest modifiable intervention targets. Clinical trial registered with clinicaltrials.gov (NCT00560859).
authors: 1 Division of Sleep and Circadian Disorders, Departments of Neurology and Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.|2 Department of Biostatistics and.
authors: Rui
authors: R
authors: Wang
authors: 3 OPKO Diagnostics, Woburn, Massachusetts.
authors: Yan
authors: Y
authors: Dong
authors: 1 Division of Sleep and Circadian Disorders, Departments of Neurology and Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors: Jia
authors: J
authors: Weng
authors: 4 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors: Emily Z
authors: EZ
authors: Kontos
authors: 5 Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, Michigan.
authors: Ronald D
authors: RD
authors: Chervin
authors: 6 Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors: Carol L
authors: CL
authors: Rosen
authors: 7 Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania; and.
authors: Carole L
authors: CL
authors: Marcus
authors: 1 Division of Sleep and Circadian Disorders, Departments of Neurology and Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.|8 Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors: Susan
authors: S
authors: Redline
mesh_terms: D001741:Black or African American; D002648:Child; D002675:Child, Preschool; D005006:Ethnicity; D005260:Female; D054624:Health Status Disparities; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D011203:Poverty; D012111:Residence Characteristics; D012720:Severity of Illness Index; D020954:Single-Parent Family; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology* / Q000503:physiopathology; D012923:Social Class; D044465:White People
keywords: health disparities; pediatrics; poverty; risk factors