Lower household income associated with worse cardiovascular outcomes in sleep apnea

NASHVILLE, Tenn. — Patients with obstructive sleep apnea and lower household income had higher odds of acute myocardial infarction, all-cause mortality and cardiac arrest, according to data presented at the CHEST Annual Meeting.

“Income disparity has been a major factor in determining hospitalizations and outcomes of several diseases. We have noted this time and again in our clinical practice,” Sashwath Srikanth, MD, first-year postgraduate at East Carolina University Health Medical Center in Greenville, North Carolina, told Healio. “Specifically, diseases like OSA can initially present with very mild and perhaps unremarkable symptoms. OSA causes daytime sleepiness and a lack of concentration. You can imagine that patients in the lower income groups cannot afford to miss a day of work and are more likely to ignore a headache, tiredness or sleepiness. However, these symptoms can snowball into further complications leading to hospitalizations.”

Researchers utilized the 2018 National Inpatient Sample to identify 2,139,840 OSA-related hospital admissions and assessed the impact of household income on in-hospital outcomes among this patient population. Patients were categorized into four quartile groups based on household income with quartile 1 being the lowest and quartile 4 being the highest.

All-cause mortality, acute myocardial infarction, stroke and cardiac arrest served as the study’s primary outcomes. Secondary outcomes included patient hospital discharge and hospital length of stay.

Patients in the lowest vs. highest income quartile were younger (median age, 63 vs. 67 years), and a greater proportion were women (48.1% vs. 37.9%), Black (27.3% vs. 7.5%) and uninsured (2.2% vs. 1.2%), whereas a smaller proportion were white (61.7% vs. 81.5%; P < .001 for all).

Crude OSA prevalence appeared greater among patients in the higher three income quartiles than the lowest income quartile group (7.2% vs. 6.6%; P < .001).

Compared with patients in the highest income quartile, a greater proportion of patients in the lowest income quartile had diabetes (53.1% vs. 41.8%), obesity (52% vs. 42.8%), smoking history (45.7% vs. 39.3%), hypertension (66.5% vs. 65.3%), congestive heart failure (24.4% vs. 18.7%), chronic pulmonary disease (42.6% vs. 31%), drug abuse (3.8% vs. 2.1%) and had lower hyperlipidemia frequency (53.4% vs. 58.4%; P < .001 for all).

A greater proportion of patients in the lowest vs. highest income quartile also had major adverse cardiovascular events as in-hospital outcomes (9% vs. 8.3%; P < .001).

In addition, patients in the lowest income quartile had higher odds of all-cause mortality (OR = 1.12; 95% CI, 1.02-1.22), cardiac arrest (OR = 1.21; 95% CI, 1.09-1.34), acute myocardial infarction (OR = 1.24; 95% CI, 1.15-1.34) and major adverse cardiovascular events (OR = 1.16; 95% CI, 1.11-1.22) compared with patients in the highest income quartile.

According to the researchers, being aware of underdiagnosed OSA among lower household income groups, timely screening measures and preventative measures may reduce disparities in health care based on socioeconomic status as well as improve long-term cardiovascular outcomes.

“Awareness of underdiagnosed OSA in the lower income group, timely screening measures, and preventive strides may curtail health care disparities based on socioeconomic status and improve long-term cardiovascular outcomes,” Srikanth said.

“We plan to take a two-pronged approach moving forward. Firstly, we plan to determine the impact of other social factors like access to health, education, neighborhood, social demographics on cardiovascular outcomes in a variety of disease conditions,” Srikanth said. “Secondly, we aim to understand in further detail which social factor is the highest determinant of cardiovascular outcomes. Further, prospective studies and clinical trials need to be done to verify our findings.”

Reference:

Srikanth S, et al. Chest. 2022;doi:10.1016/j.chest.2022.08.2072.