Prior research found that individual-level environmental and social indicators did not explain the racial disparity in obstructive sleep apnea syndrome. Neighborhood socioeconomic variables, risk factors for a range of adverse behavioral and health outcomes, may better explain this racial disparity and help identify modifiable intervention targets.
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.
We performed a cross-sectional analysis of data from 774 children in six cities who participated in the Childhood Adenotonsillectomy Trial. The outcome variable was the apnea-hypopnea index. Neighborhood socioeconomic variables were obtained based on 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 apnea-hypopnea index.
MEASUREMENTS AND MAIN RESULTS
Higher poverty rate and percent of single female headed households were associated with higher apnea-hypopnea index (p=0.008 and 0.002). African American race was associated with a 1.33 (1.08-1.64) fold increase in apnea-hypopnea index, adjusting for age and sex. After controlling for poverty rate or percent of single female headed households with children, the association between race and AHI levels was no longer significant (p=0.15 and 0.26), 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 percent of single female headed households with children.
Neighborhood socioeconomic variables in comparison to individual level socioeconomic indicators provide 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).