Montana Greider, MA1 • Chris R. Fernandez, MS1 • Sam Rusk1 • Yoav N. Nygate, MS1 • Dana Richardson2 • Brian Hutchinson2 • Tim Bartholow2 • Nathaniel F. Watson, MD, MS3 • Emerson Wickwire, MD, MS4
Introduction
Area socioeconomic deprivation, as measured by the Area Deprivation Index (ADI), is associated with numerous adverse health and economic outcomes (e.g., cardiovascular events, hospital readmissions, Alzheimer’s disease). This composite score is based on 17 health disparities indicators (e.g., income, education, employment, housing quality) used to rank relative disadvantage across communities, and is a widely utilized key social determinant of health and a validated marker of health risk. The purpose of this study is to determine the association between the ADI and OSA treatment initiation.
Methods
Our data source was the All-Payer Claims Database (APCD) for the Wisconsin Health Information Organization (WHIO). The APCD includes claims data (e.g., healthcare visits, procedures, pharmacy information) from health insurers, employers, and Medicaid. Inclusion criteria included continuous enrollment coverage for a minimum of 12-months prior to the date of OSA diagnosis (based on ICD code G47.33) and a diagnostic sleep test (based on CPT codes). ADI was measured at state and national levels. OSA treatment initiation was defined using Healthcare-Common-Procedure Coding System (HCPCS) codes. Rates of OSA treatment initiation were compared between individuals with OSA living in the highest and lowest ADI quantiles (e.g., the areas of greatest and least socioeconomic deprivation) using ordinary least squares (OLS) regression analysis to evaluate the directionality and significance of their association.
Results
Of N=6,026,463 participants in the overall sample, N=154,821 underwent OSA diagnostic testing, and N=43,601 were subsequently diagnosed with OSA. OSA treatment initiation was significantly, negatively associated with area socioeconomic deprivation based on National-ADI (Slope: -0.0011, p< 0.0050) and State-ADI (Slope: -0.0016, p< 0.0050). The highest rates of OSA treatment were observed in areas of greatest socioeconomic advantage (>70% in ADIs 15-25). Conversely the lowest OSA treatment initiation rates were observed in areas of greatest socioeconomic disadvantage (< 50% in ADIs 90-100), reflecting a 20% difference in the likelihood of OSA treatment between the highest and lowest levels of socioeconomic disparity.
Conclusion
Area socioeconomic deprivation measured by ADI is associated with significantly reduced OSA treatment initiation. Future research should seek to increase access to OSA care in areas of socioeconomic disadvantage to reduce sleep health disparities and achieve health equity.
