Association of household income with osa hospitalizations and outcomes: a population-based analysis

SESSION TITLE: Sleep and Sleep Apnea in Hospitalized PatientsSESSION TYPE: Original InvestigationsPRESENTED ON: 10/17/2022 1:30 pm - 2:30 pmPURPOSE: Low socioeconomic status has been linked to poor health outcomes in a variety of conditions. However, the relationship in patients with Obstructive Sleep Apnea (OSA) related admissions is not well described on a large scale. We aim to study the impact of household income on in-hospital outcomes in OSA patients.METHODS: We queried the National Inpatient Sample (2018) to identify OSA related admissions. Primary outcomes [MACCE: all-cause mortality, AMI, stroke, cardiac arrest] and secondary outcomes (patient discharge and length of stay) were compared between different income quartile groups (Q1: 0-25th, Q2: 26-50th, Q3: 51-75th, Q4:76-100th) of OSA cohort. Multivariable analyses were adjusted for confounders to assess the odds of outcomes.RESULTS: A total of 2,139,840 weighted OSA related admissions were included in this study. The higher income quartile groups (Q2, Q3, Q4) showed a higher crude prevalence of OSA compared to the lowest income quartile group (7.2% in Q4 vs 6.6% in Q1, p<0.001). Compared to patients in Q4, patients in the Q1 were younger (median age: 63 vs 67 years), more likely to be female (48.1% vs 37.9%), black (27.3% vs 7.5%), uninsured (2.2% vs 1.2%) and less likely to be white (61.7% vs 81.5%) (all p<0.001). Patients in the Q1 group, compared to the Q4 group, more frequently demonstrated diabetes mellitus (53.1% vs 41.8%), obesity (52% vs 42.8%), smoking (45.7% vs 39.3%), hypertension (66.5% vs 65.3%), CHF (24.4% vs 18.7%), chronic pulmonary disease (42.6% vs 31%), drug abuse (3.8% vs 2.1%), and showed lower frequency of hyperlipidemia (53.4% vs 58.4%) [all p<0.001]. The OSA cohort from Q1 had an overall higher rate of MACCE (9% vs 8.3%, P<0.001) as outcomes compared to the Q4 group. Multivariable regression analysis revealed higher odds of all-cause mortality (OR 1.12; CI 1.02-1.22; p=0.031), cardiac arrest (OR 1.21; CI 1.09-1.34; p<0.001), acute myocardial infarction (AMI) (OR 1.24; CI 1.15-1.34; p<0.001), and MACCE (OR 1.16; CI 1.11-1.22; p<0.001) in Q1 group vs the Q4 group.CONCLUSIONS: Although the prevalence of OSA is lower in the Q1 group, they had significantly worse outcomes and higher odds of MACCE, AMI, all-cause mortality, and cardiac arrest as compared to the Q4 group.CLINICAL IMPLICATIONS: Household income remains one of the critical social determinants of cardiovascular outcomes in OSA patients. Awareness of underdiagnosed OSA in the Q1 group, timely screening measures, and preventive strides may curtail healthcare disparities based on socioeconomic status and improve long-term cardiovascular outcomes.DISCLOSURES: No relevant relationships by Alejandrina Cuello-RamírezNo relevant relationships by Rupak DesaiNo relevant relationships by Pallavi MataiNo relevant relationships by April Kristine MiguelNo relevant relationships by Crystal MorasNo relevant relationships by Jai Sivanandan NagarajanNo relevant relationships by Hiral PatelNo relevant relationships by Aleen RahmanNo relevant relationships by Warda ShahnawazNo relevant relationships by Sashwath SrikanthNo relevant relationships by Jimmy Tavarez SESSION TITLE: Sleep and Sleep Apnea in Hospitalized Patients SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 1:30 pm - 2:30 pm PURPOSE: Low socioeconomic status has been linked to poor health outcomes in a variety of conditions. However, the relationship in patients with Obstructive Sleep Apnea (OSA) related admissions is not well described on a large scale. We aim to study the impact of household income on in-hospital outcomes in OSA patients. METHODS: We queried the National Inpatient Sample (2018) to identify OSA related admissions. Primary outcomes [MACCE: all-cause mortality, AMI, stroke, cardiac arrest] and secondary outcomes (patient discharge and length of stay) were compared between different income quartile groups (Q1: 0-25th, Q2: 26-50th, Q3: 51-75th, Q4:76-100th) of OSA cohort. Multivariable analyses were adjusted for confounders to assess the odds of outcomes. RESULTS: A total of 2,139,840 weighted OSA related admissions were included in this study. The higher income quartile groups (Q2, Q3, Q4) showed a higher crude prevalence of OSA compared to the lowest income quartile group (7.2% in Q4 vs 6.6% in Q1, p<0.001). Compared to patients in Q4, patients in the Q1 were younger (median age: 63 vs 67 years), more likely to be female (48.1% vs 37.9%), black (27.3% vs 7.5%), uninsured (2.2% vs 1.2%) and less likely to be white (61.7% vs 81.5%) (all p<0.001). Patients in the Q1 group, compared to the Q4 group, more frequently demonstrated diabetes mellitus (53.1% vs 41.8%), obesity (52% vs 42.8%), smoking (45.7% vs 39.3%), hypertension (66.5% vs 65.3%), CHF (24.4% vs 18.7%), chronic pulmonary disease (42.6% vs 31%), drug abuse (3.8% vs 2.1%), and showed lower frequency of hyperlipidemia (53.4% vs 58.4%) [all p<0.001]. The OSA cohort from Q1 had an overall higher rate of MACCE (9% vs 8.3%, P<0.001) as outcomes compared to the Q4 group. Multivariable regression analysis revealed higher odds of all-cause mortality (OR 1.12; CI 1.02-1.22; p=0.031), cardiac arrest (OR 1.21; CI 1.09-1.34; p<0.001), acute myocardial infarction (AMI) (OR 1.24; CI 1.15-1.34; p<0.001), and MACCE (OR 1.16; CI 1.11-1.22; p<0.001) in Q1 group vs the Q4 group. CONCLUSIONS: Although the prevalence of OSA is lower in the Q1 group, they had significantly worse outcomes and higher odds of MACCE, AMI, all-cause mortality, and cardiac arrest as compared to the Q4 group. CLINICAL IMPLICATIONS: Household income remains one of the critical social determinants of cardiovascular outcomes in OSA patients. Awareness of underdiagnosed OSA in the Q1 group, timely screening measures, and preventive strides may curtail healthcare disparities based on socioeconomic status and improve long-term cardiovascular outcomes. DISCLOSURES: No relevant relationships by Alejandrina Cuello-Ramírez No relevant relationships by Rupak Desai No relevant relationships by Pallavi Matai No relevant relationships by April Kristine Miguel No relevant relationships by Crystal Moras No relevant relationships by Jai Sivanandan Nagarajan No relevant relationships by Hiral Patel No relevant relationships by Aleen Rahman No relevant relationships by Warda Shahnawaz No relevant relationships by Sashwath Srikanth No relevant relationships by Jimmy Tavarez