Socioeconomic inequities in adherence to positive airway pressure therapy in population-level analysis

Abhishek Pandey, Suresh Mereddy, Daniel Combs, Safal Shetty, Salma I. Patel, Saif Mashaq, Azizi Seixas, Kerry Littlewood, Girardin Jean-Luis, Sairam Parthasarathy

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


(a) Background: In patients with sleep apnea, poor adherence to positive airway pressure (PAP) therapy has been associated with mortality. Regional studies have suggested that lower socioeconomic status is associated with worse PAP adherence but population-level data is lacking. (b) Methods: De-identified data from a nationally representative database of PAP devices was geo-linked to sociodemographic information. (c) Results: In 170,641 patients, those in the lowest quartile of median household income had lower PAP adherence (4.1 + 2.6 hrs/night; 39.6% adherent by Medicare criteria) than those in neighborhoods with highest quartile median household income (4.5 + 2.5 hrs/night; 47% adherent by Medicare criteria; p < 0.0001). In multivariate regression, individuals in neighborhoods with the highest income quartile were more adherent to PAP therapy than those in the lowest income quartile after adjusting for various confounders (adjusted Odds Ratio (adjOR) 1.18; 95% confidence interval (CI) 1.14, 1.21; p < 0.0001). Over the past decade, PAP adherence improved over time (adjOR 1.96; 95%CI 1.94, 2.01), but health inequities in PAP adherence remained even after the Affordable Care Act was passed. (d) Conclusion: In a nationally representative population, disparities in PAP adherence persist despite Medicaid expansion. Interventions aimed at promoting health equity in sleep apnea need to be undertaken.

Original languageEnglish (US)
Article number442
JournalJournal of Clinical Medicine
Issue number2
StatePublished - Feb 2020


  • Adherence
  • Big data
  • Health disparities
  • Health equity
  • Health policy
  • Positive airway pressure therapy
  • Sleep apnea

ASJC Scopus subject areas

  • General Medicine


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