Environmental, social, and health burdens in relation to sleep-disordered breathing among patients of community-based health center clinics in the United States

STUDY OBJECTIVES: We investigated associations between community-level environmental, social, and health burdens in relation to sleep-disordered breathing (SDB) prevalence and evaluated effect modification by age, sex, race, and ethnicity. METHODS: We conducted a cross-sectional study using electronic health records from 1,406,727 patients (median age: 44.0 years; 40.3% men) at U.S. community health centers in 2022. Patients' residential addresses in 2022 were linked to a census tract-level environmental, social, and health burden (ESHB) index, reflecting community socioeconomic, environmental, and health burden (percentile rank range: 0-1; higher values indicate greater burden). SDB was identified via diagnostic and procedural codes and categorized as obstructive (OSA), central (CSA), other/unspecified (OUSA), multiple sleep apneas, or procedure-based cases. Log-binomial regression estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs), with effect modification assessed using interaction terms. RESULTS: SDB prevalence was 6.0% (OSA: 4.1%; CSA: 0.03%; OUSA: 1.5%; multiple apneas: 0.04%; procedure-based: 0.2%). Each 0.1-unit increase in ESHB percentile rank was associated with higher prevalence of SDB (aPR = 1.01 [1.01-1.01]), OUSA (aPR = 1.01 [1.01-1.02]), and procedure-based cases (aPR = 1.04 [1.02-1.05]) but not CSA, OSA, or multiple sleep apneas. Stronger ESHB-OSA associations were observed among younger (18-49 vs. ≥50 years), American Indian/Alaska Native and White (vs. Asian and multiracial groups), and non-Hispanic (vs. Hispanic) patients. CONCLUSION: Higher overall census tract-level environmental, social, and health burden, as measured by the ESHB index, was associated with higher SDB prevalence with variation by sociodemographic group. Although prospective studies are warranted, our findings illuminate the potential for community-level factors to inform SDB interventions.