Original ArticleRacial disparity in sleep apnea-related mortality in the United States
Introduction
Obstructive sleep apnea (OSA) is one of the most common sleep-related breathing disorders characterized by recurrent episodes of apneas and hypopneas due to upper airway obstructions during sleep, leading to daytime sleepiness, cognitive function impairment, increased risk of traffic accidents, and decreased health-related quality of life [1]. The clinical epidemiology of sleep apnea has been well described, with the prevalence higher in males than females [2,3], Blacks than Whites [4,5], and increasing with age [6]. Worldwide, approximately 936 million people are estimated to have mild to severe OSA between the ages of 30 and 69 years of age [7]. In the United States (US), the OSA prevalence defined as an apnea-hypopnea index (AHI) greater than 5 per hour is estimated to be 15 to 30% in males and 10 to 15% in females [8,9]. Blacks have been reported to have a higher prevalence of OSA than Whites [10]. Interestingly, Chen et al. in their study, reported that Blacks had higher odds (odds ratio = 1.78) of OSA compared with Whites, but the racial difference was more pronounced among younger individuals in the Multi-Ethnic Study of Atherosclerosis Sleep Cohort [11]. Their study also observed a high prevalence of moderate or severe OSA among all groups, which was significantly elevated among Chinese and Hispanics as compared with Whites. Additionally, another study by Ancoli-Israel et al. found that Blacks over age 65 were 2.1 times more likely than Whites to have severe OSA [5].
OSA has been recognized as an important cause of medical morbidity and mortality, and contributes to the development of systemic hypertension [12], cardiovascular disease [[13], [14], [15], [16], [17], [18]], and abnormalities in glucose metabolism [19]. To our knowledge, despite several epidemiologic studies focusing on the prevalence, risk factors, and clinical presentations of sleep apnea, no study has evaluated the disparity of sleep apnea-related mortality among different racial groups. In the current study, we hypothesized that Blacks would have a higher mortality rate for sleep apnea than Whites and the mortality trend over time would vary by racial groups, which can indicate the importance of continued monitoring of these disparities. Our goal was to examine the disparity of sleep apnea-related mortality by gender, race, and geographic areas and compare the associated comorbidities and outcomes among Blacks and Whites in the US.
Section snippets
Data collection and study design
We examined mortality data for 1999–2019 from the National Center for Health Statistics (NCHS) provided by the Centers for Disease Control and Prevention (CDC). Mortality data are based on death certificates for US residents, which contain a single underlying cause of death (UCD), up to 20 additional multiple causes contributing to death but not resulting in the underlying cause, and demographic information. Using the International Classification of Diseases, 10th Revision (ICD-10), all
Sleep Apnea Mortality rates by gender, race, state, and region
From 1999 to 2019, there were a total of 17,053 deaths with sleep apnea (ICD-10: G47.3) documented as the UCD in the US (Table 1). From those, 14,127 were White, 2593 for Blacks, 142 for American Indian or Alaska Native, 191 for Asian or Pacific Islander, and 911 for Hispanic. The total age-adjusted mortality rate attributed to sleep apnea was 2.5 per 1,000,000 population, with males having a higher mortality rate (3.1/1,000,000) compared to females (1.9/1,000,000) (P < 0.001). For both
Discussion
This study provides the first systematic assessment and demonstrates remarkable demographic disparities of age-adjusted sleep apnea-related mortality in the US, with higher rates in males than females and Blacks than Whites. Overall, a steady increase in mortality was seen from 1999 to 2008, but the rate remained flat throughout the remainder of the study period. This pattern was observed in Black females and both genders for Whites. However, Black males are the only demographic group that had
Funding
None to disclose.
Author contributions
Y. L. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Y. L., K. C., and M. J. M. contributed to the literature review, study concept and design, data analysis and interpretation. Y. L., K. C., and M. J. M. contributed to the writing and revision of the manuscript.
Financial/nonfinancial disclosures
Drs Lee, Chang, and Mador have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Role of sponsors
The sponsors had no role in the study design, data analysis, writing of the manuscript, or the decision to submit the manuscript.
Other contributions
The authors would like to thank the National Center for Health Statistics and the Centers for Disease Control and Prevention for providing the dataset.
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